Held over a distance: A qualitative study on patients’ experiences of Internet- based cognitive behaviour therapy (ICBT) for antenatal depression with added live support sessions

Held over a distance: A qualitative study on patients’ experiences of Internet- based cognitive behaviour therapy (ICBT) for antenatal depression with added live support sessions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Held over a distance: A qualitative study on patients’ experiences of Internet- based cognitive behaviour therapy (ICBT) for antenatal depression with added live support sessions Sandra Frööjd, Ida Emilsson, Hanna Ulfsdottir, Maude Johansson, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9093942/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Antenatal depression is common and often remains untreated. Few studies that have evaluated pregnancy-adapted internet-based cognitive behavioural therapy (ICBT). Although these studies indicate promising treatment effects, participants frequently report feelings of loneliness, being overwhelmed, and a desire for increased interaction. With the DANA-project, we attempt to address these needs by incorporating live support sessions to a pregnancy-adapted ICBT-treatment, providing increased support and contact with two clinicians. This study explores participants' experience of this treatment. Methods: We conducted a qualitative study using semi-structured interviews with participants (n=20) who had received a 10-week guided ICBT for antenatal depression, complemented with live support sessions delivered by a midwife over video or telephone. The data were analysed using reflexive thematic analysis. Results: One overarching theme was generated, named ‘ Feeling held over a distance – the interplay of Support and Obligation ’, comprising three themes representing the participants’ experiences of the treatment. Participants described the treatment as supportive and validating, with many elements perceived as helpful, indicating that the key elements of the treatment were well received. Participants emphasized the value of the therapeutic relationship, the relevance of the content, and the emotional resonance of the treatment. At the same time, they experienced the program as demanding, reporting a high level of burden, both related to the illness itself, the treatment, and other life circumstances. A strong wish for personal tailoring was evident. The support sessions were valued, offering opportunities for individualised guidance and contributing to a deeper therapeutic relationship. Conclusions: Participants in therapist-guided ICBT for antenatal depression with added live support sessions delivered by a counsellor, appreciated the treatment but reported substantial burdenthat may affect perceived feasibility. Personal tailoring of both structure and content was highly valued, and although this was described as present, participants expressed a desire for more. Feeling seen was repeatedly highlighted as a valued aspect of the intervention. These findings may informrefinement of perinatal digital interventions and guide future implementation efforts. Trial registration: The study was a sub-study in a prospectively registered randomized controlled trial conducted in Sweden, the DANA project. Trial registration: ClinicalTrials.gov, NCT05533138. Registered 9 September 2022. Antenatal depression ICBT Treatment Pregnancy Additional Support Perinatal mental health Reflexive thematic analysis Blended treatment Figures Figure 1 Figure 2 Background Antenatal depression affects approximately 9% of the pregnant population in high income countries and 19% in low- and middle-income countries [ 1 ]. It is associated with adverse psychological and physiological health outcomes for the mother and foetus [ 2 ]. Antenatal depression often remains untreated since it is often missed within the healthcare system, and access to psychological treatments remains limited [ 3 , 4 ]. In addition, patients may be reluctant to seek help for fear of stigmatization, prioritize the unborn baby’s needs over their own, be concerned about being offered pharmaceutical treatment, and have practical barriers such as lack of time and childcare issues [ 5 – 7 ]. Cognitive behavioural therapy (CBT) is a recommended first-line treatment of mild to moderate perinatal depression [ 8 , 9 ]. Evidence indicates that CBT is effective in reducing perinatal depressive symptoms, however, further research is needed to strengthen the evidence base and inform implementation [ 10 – 14 ]. Internet-based psychotherapeutic interventions offer practical advantages that may improve access and engagement, they are cost- and time-efficient and allows flexible use. Furthermore, internet-based delivery may reduce perceived stigma, thereby reducing barriers to treatment access [ 5 , 15 ]. Therapist supported, Internet-based cognitive behavioural therapy (ICBT) has strong empirical support for treating depression in the general adult population and is as effective as face-to-face CBT [ 16 , 17 ]. A few studies have evaluated pregnancy-adapted ICBT programs with promising findings, but more research is needed [ 18 – 21 ]. When asked about their experience of participating in ICBT, both the perinatal group and the general population emphasize a sense of loneliness and feeling overwhelmed [ 22 – 25 ]. While ICBT is generally appreciated, it is also described as demanding and many participants reports that they would have valued more live contact with their therapist [ 25 – 30 ]. It has been hypothesized that increased support and real-time interaction could enhance motivation and improve treatment completion [ 27 , 29 , 31 ]. Prior studies suggest that treatment manuals may need to be adapted to the perinatal state to increase adherence and acceptability, as the participants indicate a higher level of motivation when the interventions are perceived as relevant or tailored to their needs [ 7 , 27 , 28 , 32 , 33 ]. The perinatal group also expresses a desire for dignity, continuity and individualization in their care [ 7 , 22 , 34 ] and show a preference for treatments that include live contact [ 35 ]. Accommodating for patients' preferences in treatment can be associated with decreased dropout rates and stronger therapeutic alliance [ 36 , 37 ]. It has been hypothesized that blended approaches, combining face-to-face and internet-based therapy and thereby retaining the advantages of both synchronous and asynchronous contact, will become an attractive option in the future [ 21 , 38 ]. Adherence to ICBT varies considerably and is influenced by factors such as level of support, therapist role, and patient characteristics [ 39 – 41 ]. Reported reasons for lack of adherence include high workload with, and perceived complexity of the material, lack of motivation, and a mismatch between the treatment process and participants’ expectations, but also more positive aspects such as improvement in symptoms leading to a perceived lack of need for continued treatment [ 42 , 43 ]. These challenges underscore the importance of strategies that promote sustained engagement. Our research group previously developed and tested a pregnancy-adapted ICBT treatment with text-based therapist support for antenatal depression compared to regular maternal health care [ 18 ]. The treatment had a large effect size (Hedges g = 1,2) and while adherence was comparable to similar interventions, there is still room for improvement [ 18 , 21 ]. Adherence has been hypothesized to be a critical factor for achieving positive outcomes in ICBT interventions. Therapist-guided treatments have been shown to improve adherence and symptom reduction and lower attrition rates compared to unguided interventions [ 41 , 44 – 47 ]. Qualitative research further emphasizes therapist support as essential for adherence, particularly in personalizing treatment, fostering therapeutic alliance and managing emotions [ 40 ]. These findings suggest that integrating guidance into digital interventions can improve adherence, engagement, and treatment efficacy; however, the optimal level or type of support required to maximize outcomes remains unclear [ 41 ]. For example, one study found that enhanced support improved adherence without affecting outcome [ 48 ], highlighting the complexity of this relationship. The present study is a sub-study of a trial with the aim to improve adherence and address the specific needs of the perinatal population by integrating synchronous support sessions with a counsellor into therapist-guided ICBT. This blended format where the patient interacts with two clinicians may offer increased personalization and real-time interaction, however little is known about how patients experience such a treatment. Interacting with more than one clinician may introduce challenges such as coordination difficulties, higher costs, and reduced therapist decisiveness, but it could also enrich the therapeutic experience by providing diverse perspectives and stronger alliances [ 49 – 51 ]. Therefore, the current study aims to explore patients’ experience of therapist-guided ICBT with added synchronous support sessions provided by a clinician experienced in perinatal care, with a particular focus on perinatal support and treatment personalization. Given the limited research on the involvement of multiple clinicians in ICBT is limited, we also aim to explore patients' experiences of these aspects. Methods Study aim This study aims to explore the patients’ experiences of enhanced support in ICBT for antenatal depression, combining traditional, written, therapist guidance from a clinical psychologist with live support sessions delivered through video, telephone or in person, by a clinician experienced in perinatal psychiatry. Study design The study was a qualitative interview study, included as a sub-study in a randomized controlled trial conducted in Sweden, the DANA project. Trial registration: ClinicalTrials.gov, NCT05533138, registered 9 September 2022. The data was collected using semi-structured interviews with patients and analysed using reflexive thematic analysis. Baseline characteristics were included from self-report measures collected upon self-referral. The DANA project In the DANA project, individuals in pregnancy week 8-29 were recruited nationally (Sweden) via ads in social media and through maternal health care clinics. Diagnostic assessment was performed by clinicians trained in diagnostic assessment and supervised by experienced perinatal psychiatric clinicians. Assessment consisted of a structured diagnostic interview (DSM-5 for depression and M.I.N.I. for other psychiatric diagnoses) as well as mental and physical health factors associated with pregnancy. Those who fulfilled inclusion criteria after assessment (adults in pregnancy week 8-30; mild to moderate depression; ability to perform ICBT and without severe mental or physical conditions, treatment with similar psychotherapy or recent medication change) were randomized (1:1) to either receive pregnancy-adapted ICBT for depression guided by a CBT-trained therapist or the same treatment with an addition of up to three sessions with added live support sessions. Participants were blind to treatment allocation. Participants and recruitment Participants recruited for the purpose of this study were among those that had been randomized to ICBT with the synchronous support sessions and had to have completed at least one module or one support session. A combination of criteria sampling and convenience sampling [52] was applied where all participants who were eligible for the study were asked to participate during three specific timeframes, due to practicalities (between March and April of 2023, April and May of 2024 and August 2024). In the second and third period criteria sampling was used with stratification based on responsible therapists to enable diversity. Adequate sample size was guided by information power [53] with the aim to offer new insights that can influence further development of perinatal care. A total of 23 participants were contacted. Three declined to participate and 20 participants contributed to the qualitative study. The mean age of the included participants was 32 years. For more demographic information please see Table 1. Participants are referred to by number (e.g. P1 represents Participant 1). For confidentiality reasons, demographic details are not connected to individual participants. Table 1. Baseline characteristics and treatment engagement (n = 20). Legend: The Montgomery-Åsberg Depression Rating Scale Self-report version (MADRS-S) collected at baseline was used for baseline-data. It is a widely used and validated scale for measuring depression [54, 55], with a maximum score of 54. Treatment The treatment protocol, without the addition of synchronous support sessions, had previously been tested in a randomized controlled trial [18]. The treatment was a guided self-help treatment consisting of a ten-week ICBT program adapted for antenatal depression. The treatment was delivered via an online platform and was structured around ten modules containing texts, assignments, and exercises. The modules addressed areas such as psychoeducation, behavioural activation, and cognitive coping strategies (see Figure 1). The participant had regular asynchronous contact in the treatment platform, with a CBT-trained clinical psychologist or a final-semester psychology student under supervision, referred to as the therapist in the article. The therapist provided feedback, encouragement and support in written messages. Alongside contact with the therapist on the platform, patients were offered up to three synchronous support sessions in an integrated manner. All patients included in this study received support sessions through digital format (telephone or video). Patients played an active role in choosing how many of these sessions to use, at what point during treatment, and their content. The support was provided by a midwife, referred to as the counsellor in this article. Participants were informed that the counsellor was familiar with the content of the treatment and experienced in working with the perinatal population. They were also informed that the therapist and the counsellor communicated with each other before and after each session. The purpose of the support sessions was described as providing additional space to talk about their well-being and treatment progress. Suggested topics included common pregnancy-related difficulties, anxiety, relationship problems, and support to improve treatment adherence through e.g. individualised problem-solving strategies. To facilitate communication a worksheet was used within the platform, filled out before and after the sessions by the patient, therapist and counsellor. The therapist and counsellor could also communicate outside this format during a weekly clinical meeting, and, when needed, by phone. Data collection A qualitative semi-structured interview guide covered participants’ overall treatment experiences, perceptions of the live support sessions, experiences of the dual-clinician format, unmet needs and perceived helpful components. The interview guide was continuously discussed in the research group and developed during the data collection. The interviews were performed over the telephone by two psychologists (n = 11) and two master students in clinical psychology (n = 9). All interviewers had worked as therapists within the DANA-project. One (SF, the first author) had also worked as a counsellor within the project. None had worked clinically with the participants they interviewed. The average length of the interviews was 25 minutes (range = 9 to 50 min). The interviews were audio-recorded and transcribed verbatim by the interviewer. Half of the interviews were transcribed with the help of an AI-supported transcription service (Whisper), compliant with institutional data-protection requirements. All transcripts were manually verified. Baseline characteristics were included from self-report measures collected upon self-referral. Qualitative analysis Data was analysed with an iterative process of mainly inductive reflexive thematic analysis [56–58] using NVivo 15 software. Our reflexive thematic analysis is underpinned by a critical realist ontology. This reflects a belief that there is a pursuable reality that cannot be captured in its purest form. As our perception of reality is inevitably shaped by social context, an epistemological concern with the importance of context and a striving to find truth within this context is necessary [58]. Reflexive thematic analysis was chosen because it provides an accessible and flexible method which gives an opportunity for the data analysis to be both inductive and/or iterative as well as having an experiential semantic approach within a pragmatic paradigm [58]. The Reflexive Thematic Analysis Reporting Guidelines (RTARG) have been used as a guide when designing, executing, and writing this article [59]. SF and IE read the transcripts several times to get familiarized with the data, creating written reflections during this process. Initial codes were then generated line-by-line. SF performed most of the initial rigorous coding, with assistance from IE. Codes, as well as themes, were created in an iterative process in search of common meanings, with the use of movable notes to aid in this process. Discussions were held on several occasions in the research group with an aim to reach consensus without ignoring how the analysis and the themes were developed. SF then returned to the data to re-evaluate. Thereafter, themes were defined and named to verbalize their content, and the manuscript was written, including citations to illustrate the analysis. Interview quotes were translated from Swedish to English for reporting purposes. Reflexivity The research group maintained a continuous reflexive stance throughout the analysis process. Through ongoing journalling and regular discussions, we examined how our own backgrounds and experiences, such as lived experience of perinatal depression and our roles as both developers and therapists of the treatment being evaluated, may have shaped our conceptualization of the study as well as our interpretations of the data. Results Feeling held over a distance – The Interplay of Support and Obligation The experiences of the participants were summarized into one overarching theme, including three major themes (see Fig. 2 ). Participants described the treatment as a whole to be one where they felt genuinely seen and supported, and where many elements were perceived as helpful. They highlighted the value of the therapeutic relationship with the therapist and the counsellor, the relevance of the written modules, and the validating nature of the treatment. At the same time, the participants experienced the treatment as demanding, and they expressed a strong wish for personal tailoring of both the pacing and of the components of the treatment including the amount and format of materials. The synchronous support sessions were a valued part of the treatment, offering opportunities for individualised guidance and contributing to a deeper therapeutic relationship. While participants clearly expressed a need for further adaptation, their accounts also reflect the complexity of optimizing psychological treatments. Legend: The figure illustrates the overarching theme “Feeling held over a distance – the interplay of Support and Obligation” and the three themes developed through reflexive thematic analysis: (1) Seen and Supported, (2) Carrying the Weight of Demands, and (3) The Need for Individualized Tailoring. Seen and supported This theme captures participants’ experiences of feeling emotionally acknowledged and supported throughout the treatment. The accounts reflect how therapeutic presence, relational aspects, and personalization across the treatment as a whole contributed to a sense of being seen, validated, and emotionally held. “The best part, overall, in the whole treatment, was the amazing way I was met. That I got to just be who I am… Because I feel that the experience in healthcare sometimes can be that you’re not feeling well, they prescribe antidepressants, and then they kind of lose track of you. And that wasn’t the experience here at all, so I think that’s something that should really be implemented much more. That there’s a red thread, and that no one just drops you and goes “bye, take care.” Instead, you feel cared for and important.” (P1) Most participants expressed appreciation for the treatment, highlighting the value of its content, the support from the therapist and the counsellor, and the overall format. They described the intervention as helpful and reported having acquired knowledge and strategies that they continued to use after the treatment. They described the modules as relevant, personalized, and supportive in relation to pregnancy and expressed that participation facilitated help-seeking in other areas of healthcare. They also described how the treatment became part of a broader process, leading to a deeper understanding of themselves and their needs, including the realization that they were depressed and identifying factors that had contributed to it. “I really felt that the treatment helped me – or, well, probably everything did, the whole package”. (P2) Participants repeatedly described the experience of the contact with the therapist and the counsellor as a relationship where they felt seen, normalized, treated with warmth, and met in their struggles. The supportive approach from both the therapist and the counsellor was described as helpful in navigating the treatment and maintaining motivation during more difficult periods. “When you were feeling the way you were, there was a lot to take in, and I had to rely a lot on support from the therapist, to get… yeah, I couldn’t sit and read through the module, it was too much for me”. (P3) Several participants stressed the importance of how the treatment helped to normalize their experiences. Feelings of shame about not being “just happy” during this period were commonly described, and the way these feelings were acknowledged and met within the treatment as a whole helped to relieve some of the shame and guilt that the participants often experienced. "The support call could still confirm for me that it’s completely normal. Well, not normal, but it’s okay to feel bad. You don’t have to be happy just because you’re pregnant." (P4) The participants also expressed an appreciation of being able to use the treatment as a space where they could express things that they feared saying in their day-to-day life. Many of the participants expressed appreciation for communicating through live conversations during the support sessions. They described how synchronous contact contributed to a deeper and more emotionally accessible therapeutic relationship. Some also raised how spoken conversation, as opposed to written communication, made it harder to remain detached from the content, evoking stronger emotional responses, which they perceived as beneficial for the therapeutic process. The format of the support sessions provided a space to talk things through, fostering a sense of safety, while also allowing for real-time feedback and reflection. The immediacy of the communication enabled follow-up questions and a sense of reciprocity, which were highly valued by several participants. These aspects appeared to contribute to building a stronger therapeutic alliance. “I think it became easier for both parties to ask follow-up questions in a direct conversation. Sure, I could get good feedback via text as well. But I probably preferred what I got over the phone. Because it was, well, a bit more detailed, more back-and-forth reasoning, I think.” (P4) A common viewpoint was that the synchronous support sessions were the most appreciated part of the treatment, and many of the participants felt that these sessions made a great difference to their mental well-being. While many participants emphasized the value of synchronous support contact, some also appreciated the sense of anonymity provided by the platform. The asynchronous format enabled openness regarding thoughts and feelings that were difficult to express in everyday life. The treatments' dual clinician format elicited mixed experiences among participants, with challenges related to it explored in a subsequent theme. Some of the participants described this treatment format as highly beneficial, enhancing the sense of being emotionally supported, and providing an opportunity to gain additional perspectives on the issues they were struggling with. “To get confirmation from several people, for someone like me who has very high demands, I can very easily dismiss it if it’s just ‘one person’ saying something, but if two people say similar things, then you can think, well okay, this probably makes sense.” (P5) Overall, these accounts suggest that the experience of ‘being seen and held’ can serve as an emotional support that reduces shame, fosters self-acceptance, and sustains motivation to engage in treatment. Participants experienced support through the treatment content, the platform text, and through direct conversations. The synchronous support sessions were described as enriching the relationship, offering a depth that was especially appreciated. Carrying the Weight of Demands Almost all participants described how demands from various sources affected them. They highlighted that the treatment itself was, in many ways, experienced as demanding, sometimes to the extent that they lacked the energy to complete all components. They also described external and self-imposed demands as unhelpful when trying to engage with the treatment. Participants generally perceived the ICBT treatment as demanding. The modular format was experienced as challenging, primarily due to the extensive amount of text and the complexity of some of the assignments. Many also described the treatment as intense in terms of pace, which contributed to it being experienced as time-consuming. Combined with symptoms of depression, the treatment could feel overwhelming and burdensome. “... it felt like the treatment itself also became a demand .” (P6) Other aspects of the treatment structure that were described as challenging by some of the participants included the dual-therapist model. Participants mentioned having to repeat themselves, the potential for misunderstandings, and the emotional effort required to build relationships with two clinicians instead of one. Some found this setup confusing, fragmented, and unnecessary. Those who expressed such concern often preferred having one consistent therapist who could provide both the structured ICBT and the support sessions. “It could be good for it to be the same person because that means you’ll feel closer to that one person… and like… [the therapist] definitely knew... more about what was happening with me day to day and so then expanding on that with her could be good... or like... you know having a video call with her could be good.” (P7) Several participants described a lack of energy or motivation to fully engage with the treatment, often due to the demands of their everyday lives. They explained how life “came between” them and the treatment, listing how full-time work or studies, family responsibilities, or moving house, consumed all their time and made it impossible for them to focus on the treatment. Some participants also noted that pregnancy, and the emotional and physical demands that came with it, limited their ability to participate in the treatment. Concerns about the course of the pregnancy or fears of a potential preterm birth shifted their focus and made the treatment feel less relevant or urgent. Several participants repeatedly spoke about self-imposed demands. They described placing high expectations on themselves and a perfectionist side, which seemed to undermine their capacity to engage meaningfully with the treatment. This perfectionist tendency appeared to reduce participants’ tolerance for partial engagement or imperfection in their treatment efforts. Many experienced heavy workloads and feelings of inadequacy and had questions that they never raised with their therapist or the counsellor. This appeared not to reflect a lack of trust in the clinicians, but rather a lack of ability to ask for help or request adjustments. A recurring mindset emerged: " either I do it all, or I do nothing ", which often led to decreased engagement. P8´s account illustrates how stress and self-imposed pressure can interfere with prioritizing treatment even when the need for support is acknowledged. “ Yes, but it was a bit harder to… Well, especially when you’re feeling bad yourself and it depends on you and taking the time and prioritizing it. I thought it was difficult because I was also very stressed during that period .” (P8) Participants’ experiences revealed a conflict between the structured demands of the ICBT treatment and the unpredictable, often overwhelming nature of their daily lives. This mismatch appeared to create barriers to sustained engagement, particularly when life circumstances competed for time and emotional resources. Self-imposed expectations and perfectionist tendencies further complicated participation, with some describing an all-or-nothing mindset that hindered flexibility. Together, these findings highlight the need for tailoring of workload and pacing, even within structured digital interventions. The need for individualized tailoring This theme addresses the recurring mentions of the need for individualization. Participants wanted more time and flexibility; the fast pace sometimes caused them to rush through the material, negatively affecting both their engagement and the potential benefits. Many appreciated the idea of a longer treatment period to reduce time pressure and a reduction in the reading material. “I think it would have been easier if the reading hadn’t felt so heavy. Maybe if it had been shorter, with more modules instead, more broken down into smaller parts.” (P2) A few participants also expressed that they would have wanted more live contact or more support sessions during their treatment period. “I probably needed, like, more frequent, more conversational contact.” (P3) Some participants requested alternative formats, like having the material read aloud or presented through video. Participants also emphasized the importance of technical simplicity and accessibility. When experiencing mental distress, they described having limited capacity to troubleshoot or navigate complex systems, underscoring the need for a treatment that is easy to use and free from technical issues. While support sessions were appreciated as a form of adaptation, participants also noted that the interactions could be further tailored to better address individual emotional and contextual needs. Some participants wished for more structure, addressing how that could have improved their engagement with the treatment during the treatment period as well as after. “ Maybe a bit more support on how to review, like different parts, would have been good, because not that much gets done now .” (P10) The participants appreciated being guided by the therapist, for example, when the therapist identified moments where they seemed stuck and suggested topics that could be discussed during their session with the counsellor. This proactive guidance was experienced as valuable, helping to make use of the treatment more effectively. The therapist and the counsellors’ distinct professional roles were perceived as enriching, as it allowed for multiple perspectives and different ways of relating to oneself. It was also considered helpful to raise different topics with each clinician, depending on their respective area of expertise [psychologist or midwife with psychiatric competence]. The support sessions were often used to address concerns that lay outside the core treatment content, such as anxiety related to pregnancy and other concerns revolving around pregnancy and childbirth. Addressing different types of issues with the therapist and the counsellor also helped clarify their individual roles, which some participants felt reduced confusion. Many valued the flexibility that ICBT offers. The ability to make choices regarding when and how to engage with the treatment was described as fostering a sense of autonomy and control. Participants appreciated the person-centred adaptations included in the treatment, for example being able to select the later modules and influence the timing and content of support sessions, which contributed to a more personalized experience. However, the fixed nature of the program content – especially in text format – was sometimes seen as rigid and not always aligned with participants’ needs or preferences. This rigidity was seen as a barrier to engagement, especially when the material felt irrelevant or too simplistic. Overall, participants’ accounts underscore the importance of a treatment that is not only structured and supportive but also responsive to individual needs and preferences. The analysis highlighted the importance of the clinicians’ active role in tailoring suggestions and guidance to each participants’ specific concerns. Discussion The participants’ experiences indicate that therapist-guided ICBT with added synchronous support by a clinician other than the therapist is an appreciated treatment option, where the support sessions are viewed as an opportunity for discussions that are more in-depth. Participants often experience a high level of burden, both related to treatment and to other areas of life. This has an impact on the feasibility of the treatment and should be acknowledged both during implementation and, more broadly, in settings where perinatal care is delivered. Interacting with two clinicians provided a possibility to gain perspectives from different professions but was sometimes perceived as hindering. Previous research shows that perinatal populations value personal tailoring [ 7 , 34 ], which our findings support. Some participants noted that support sessions could feel burdensome, and preferences varied regarding the timing and amount of support. This draws attention to the importance of flexibility in both timing and frequency, and of assessing individual needs to ensure that the right level of support is offered. Together, these findings highlight not only a strong appreciation for support, but also considerable variation in how and when such support is experienced as helpful. The lack of energy and motivation described by many participants may reflect core symptoms of depression and seems to impair the engagement in the treatment. External factors such as childcare responsibilities and workload also affected participants’ ability to fully engage. In this study the participants consistently described the support sessions as helpful and appreciated. Evidence on symptom reduction through support sessions is limited [ 60 – 62 ] but our participants’ accounts suggest that the sessions were valued and provided a sense of being “held” during a vulnerable period, which may contribute to well-being beyond lower levels of depressive symptoms. The support sessions were delivered through video or telephone rather than the asynchronous written messages from the regular therapist, and it is unclear whether it would have been perceived as equally helpful if provided by the therapist instead of the counsellor. Several participants indicated that they would have preferred having the same person for both types of contact. Patients often wish for more direct contact [ 28 , 29 , 31 ], and participants’ positive views of the support sessions may reflect the value of personal interaction rather than the involvement of an additional clinician. In this context, the support sessions are intertwined with the value of synchronous contact, making it difficult to disentangle the importance of extra interaction from that of increased immediacy. Interestingly, although participants received more support than is typical in ICBT, some still wished for additional contact. At the same time, many did not utilise all available sessions., highlighting the gap between expressed preference and actual use. This pattern is in line with findings from the ICBT literature indicating that when support is provided on demand, it is often used less frequently than scheduled support [ 63 , 64 ], despite participants expressing a desire for greater therapist contact. This apparent discrepancy underscores the importance of distinguishing between expressed preferences for support and mechanisms that contribute to therapeutic change. Wanting more or individualized support does not necessarily mean that more support will be utilized, nor that it is an effective mechanism of change and leads to improved treatment outcomes. Psychotherapy research suggests that perceived helpfulness and client preferences are often associated with engagement and satisfaction. However, these factors do not consistently correspond to clinical efficacy [ 36 , 65 ]. Such preferences may also reflect distress or discomfort with challenging treatment components or social interactions. In some cases, they may function as strategies to avoid emotionally demanding tasks [ 66 , 67 ]. There may also be patients that wish for none or low levels of support that might have benefited from higher levels. The distinction between preferences, engagement, and mechanism of change may be particularly relevant in pregnancy, a period characterized by substantial emotional, relational, and physiological change [ 68 – 71 ]. Even though guided interventions show superior outcomes compared to self-guided formats, this does not indicate a simple dose–response relationship between the amount of therapist contacts and treatment effectiveness [ 39 ]. Rather, the relevance and integration of support within a structured intervention appear more important than its quantity [ 23 ]. Support that feels meaningful and well-integrated into the treatment framework may enhance engagement more effectively than simply increasing the number of interactions. Further research is needed to clarify under which conditions and for whom additional support enhances engagement in active treatment components and improves outcomes. Beyond the amount of support provided, the quality and relational aspects of support may play a central role in how digital interventions are experienced. The theme “Seen and Supported” reflects what psychotherapy research often describes as a common factor: the therapeutic relationship that fosters hope and healing [ 72 ]. In the literature, such relational elements are considered part of therapy’s shared core [ 73 ] and techniques that may optimize the change process [ 74 ]. Given the challenges of establishing causality, it remains uncertain whether therapeutic effects are driven primarily by common or specific factors, or by an interplay of both [ 72 ]. The latter have been demonstrated in one study, where the effect of adding therapist support to a self-help intervention was shown to improve outcome mainly through increasing the adherence to the most effective, but also most demanding, techniques [ 75 ]. However, from the participants perspective in this study, feeling acknowledged and validated emerged as central. They described how the support from the therapist and the counsellor contributed to a sense of warmth and recognition. How these relational elements are perceived and utilized may vary across subgroups within the perinatal population. Prior evidence links perfectionism to perinatal depression [ 24 , 76 ] and our findings echo this tendency. Some participants reflected on high self-expectations that affected engagement and that they often did not voice during treatment. The treatment often reaches highly educated, full-time working expecting mothers experiencing depression, for whom self-imposed demands may be particularly influential. Consequently, interventions may need to be even more clearly tailored for this group, ensuring that content and delivery align with their specific circumstances. At the same time, these findings invite reflection on the limits of individual tailoring in digital interventions. Increased flexibility may not always improve outcomes and may add complexity or pressure to an already vulnerable situation, as well as increasing resource demands. Further research is needed to clarify when additional support enhances engagement and outcomes, and when it may increase strain. Strengths and limitations Some limitations of this study must be noted. Firstly, the interviews were performed over the telephone, where non-verbal communication is weakened, which might have reduced the opportunities for follow-up questions and deeper understanding. Secondly, since the interview used a semi-structured interview guide, there is a risk that the participants' free narrative was restricted if the guide steered the conversation too rigidly. Thirdly, there is always a risk that participants answer in ways they believe are expected; however, the diversity of responses, including both positive and negative experiences, suggests that they felt safe expressing themselves. A fourth limitation is that interviews were conducted only with participants who chose to take part in at least one support session. Those who participated in the treatment but declined the support sessions were not reached. Gaining insight into the experiences of individuals who actively opt out of support sessions is likely a valuable perspective for informing future improvements in clinical care. A key strength of this study is the use of semi structured interviews with a relatively large qualitative sample, allowing for rich and nuanced exploration of participants’ experiences of ICBT during pregnancy. The qualitative design enabled an in-depth understanding of how treatment was perceived and integrated into participants’ everyday lives, providing clinically relevant insights. In the DANA project we will also have the opportunity to examine how additional support through support sessions impacts adherence, depression severity and satisfaction. Conclusions Participants in therapist-guided ICBT for antenatal depression with added live support sessions by a clinician other than the therapist express an appreciation for the treatment, but also report a high level of burden, which may influence perceived feasibility. Participants expressed a clear desire for personal tailoring of structure as well as content in the treatment. These findings can be used to further refine the treatment of antenatal depression and, more broadly, interventions offered during the perinatal period. The experience of feeling seen was repeatedly emphasised as a valued aspect, both within the text-based content and in interactions with the counsellor through video or telephone. This finding displays the potential for at least some common factors to be communicated within asynchronous contexts, challenging assumptions about their dependence on real-time interaction. While participants expressed a need for further adaptation and more contact, their accounts also reflect the complexity of optimizing psychological treatments. It remains unclear whether more tailoring would necessarily improve their experience of the treatment further, or whether it might add further complexity to an already challenging process. Abbreviations CBT - Cognitive behaviour therapy ICBT - Internet-based cognitive behaviour therapy Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki guidelines and regulations. Ethical approval was obtained from the Swedish Ethical Review Authority (original approval Dnr. 2020-06049, amendments Dnr. 2022-04575-02 and Dnr 2024-00796-02). Digital informed consent was obtained from all participants. Consent for publication All participants signed a digital consent form that included a statement for agreement to use their data for publication purposes. Availability of data and materials Anonymised qualitative data can be made available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This work is supported by Söderström Königska Foundation (SLS-941378, SLS-941098, SLS-969514, SLS-982400, SLS-982143, SLS-995658), FORTE (2021-00867), Bror Gadelius Memory Foundation (129900957728, 129900529626), Allmänna BB Minnesfond (FoUI-1012658), Thuring Foundation (2020-00627, 2021-00692, 2022-00746, 2023-021), KI (FS-2024-0017) and The Swedish Society of Medicine, SMM (SLS-1023187, SLS-1023020). No sponsor took any part in the design, execution, analysis, interpretation or publishing decisions of the study. Authors’ contributions SF: Writing – original draft, Writing – review & editing, Visualization, Validation, Methodology, Investigation, Project administration, Formal analysis, Data curation, Conceptualization. IE: Writing – review & editing, Investigation, Validation, Project administration, Methodology, Investigation, Formal analysis, Data curation. HU: Writing – review & editing, Validation, Supervision, Methodology, Formal analysis. MJ: Writing – review & editing, Methodology, Formal analysis, Validation, Supervision. EF: Writing – review & editing, Resources, Methodology, Funding acquisition, Supervision. VK: Writing – review & editing, Supervision, Resources, Methodology, Investigation, Funding acquisition, Conceptualization. MB: Writing – review & editing, Validation, Data curation, Project administration, Funding acquisition, Resources, Supervision, Investigation, Conceptualization. Acknowledgements We are very grateful, and would like to acknowledge, the study participants who contributed to the interviews. We would also like to thank Mona Azami Naeini and Malin Österberg for their excellent contribution in conducting a part of the interviews and participating in the development of the interview guide. We thank Petra-Sara Falk, Eva-Marie Nordenadler, Peter Lindhamre, Philippa Karlsson, Emelie Svanerud George, Kristin Öster, Malin Wiman, Sarah Ericsson and Athina Katramadou for all their work within the treatment and the study, and we would also like to acknowledge all participating student therapists. Lastly, we thank the Consultation–Liaison Unit at Psychiatry Southwest, who made the execution and implementation of ICBT for antenatal depression possible. Authors’ information SF is a clinical psychologist and PhD student. IE is a clinical psychologist. HU is a midwife, an associate professor, and holds a PhD. MJ is an associate professor, specialist in clinical psychology and holds a PhD. MB is a perinatal psychiatrist and holds a PhD, VK is a psychologist and a professor of clinical psychology. EF is a clinical psychologist and a postdoc. References Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86–92. https://doi.org/10.1016/j.jad.2017.05.003. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020;19:313–27. https://doi.org/10.1002/wps.20769. McNicholas E, Boama-Nyarko E, Julce C, Nunes AP, Flahive J, Byatt N, et al. Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History. J Womens Health 2002. 2023;32:1111–9. https://doi.org/10.1089/jwh.2022.0306. Sambrook Smith M, Lawrence V, Sadler E, Easter A. Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ Open. 2019;9:e024803. https://doi.org/10.1136/bmjopen-2018-024803. Dähn D, Rudolf S, Pawils S, Renneberg B. Perinatal mental health literacy: knowledge, attitudes, and help-seeking among perinatal women and the public – a systematic review. BMC Pregnancy Childbirth. 2022;22. https://doi.org/10.1186/s12884-022-04865-y. Goodman JH. Women’s Attitudes, Preferences, and Perceived Barriers to Treatment for Perinatal Depression. Birth. 2009;36:60–9. https://doi.org/10.1111/j.1523-536X.2008.00296.x. Westgate V, Manchanda T, Maxwell M. Women’s experiences of care and treatment preferences for perinatal depression: a systematic review. Arch Womens Ment Health. 2023;26:311–9. https://doi.org/10.1007/s00737-023-01318-z. Summary of the clinical practice guideline for the treatment of depression across three age cohorts. Am Psychol. 2022;77:770–80. https://doi.org/10.1037/amp0000904. Health N, Howard T, Pilling S, Adams H, Barlow J, Bavetta M, et al. CG45 Antenatal and Postnatal Mental Health—The NICE Guideline on Clinical Management and Service Guidance. 2014. Pettman D, O’Mahen H, Blomberg O, Svanberg A, Essen L, Woodford J. Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis. BMC Psychiatry. 2023;23. https://doi.org/10.1186/s12888-023-04547-9. Li X, Laplante DP, Paquin V, Lafortune S, Elgbeili G, King S. Effectiveness of cognitive behavioral therapy for perinatal maternal depression, anxiety and stress: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev. 2022;92:102129. https://doi.org/10.1016/j.cpr.2022.102129. Smith RD, Dang W, Shen S, Hung SC, Lam IH, Kwok JYY, et al. Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis. Asian J Psychiatry. 2025;103:104316. https://doi.org/10.1016/j.ajp.2024.104316. Waqas A, Zafar SW, Akhtar P, Naveed S, Rahman A. Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis. Camb Prisms Glob Ment Health. 2023;10:e22. https://doi.org/10.1017/gmh.2023.8. Shortis E, Warrington D, Whittaker P. The efficacy of cognitive behavioral therapy for the treatment of antenatal depression: A systematic review. J Affect Disord. 2020;272:485–95. https://doi.org/10.1016/j.jad.2020.03.067. Cuijpers P, Riper H. Internet interventions for depressive disorders: An overview. Rev Psicopatología Psicol Clínica. 2014;19:209–16. https://doi.org/10.5944/rppc.vol.19.num.3.2014.13902. Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther. 2018;47:1–18. https://doi.org/10.1080/16506073.2017.1401115. Hagi K, Kurokawa S, Takamiya A, Fujikawa M, Kinoshita S, Iizuka M, et al. Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry. 223:407–14. https://doi.org/10.1192/bjp.2023.86. Forsell E, Bendix M, Holländare F, Szymanska von Schultz B, Nasiell J, Blomdahl-Wetterholm M, et al. Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial. J Affect Disord. 2017;221:56–64. https://doi.org/10.1016/j.jad.2017.06.013. Ashford MT, Olander EK, Ayers S. Computer- or web-based interventions for perinatal mental health: A systematic review. J Affect Disord. 2016;197:134–46. https://doi.org/10.1016/j.jad.2016.02.057. Loughnan SA, Joubert AE, Grierson A, Andrews G, Newby JM. Internet-delivered psychological interventions for clinical anxiety and depression in perinatal women: a systematic review and meta-analysis. Arch Womens Ment Health. 2019;22:737–50. https://doi.org/10.1007/s00737-019-00961-9. Canfield SM, Canada KE. Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations. J Perinat Neonatal Nurs. 2023;37:14. https://doi.org/10.1097/JPN.0000000000000658. Massoudi P, Strömwall LA, Åhlen J, Kärrman Fredriksson M, Dencker A, Andersson E. Women’s experiences of psychological treatment and psychosocial interventions for postpartum depression: a qualitative systematic review and meta-synthesis. BMC Womens Health. 2023;23:604. https://doi.org/10.1186/s12905-023-02772-8. Pettman D, O’Mahen H, Svanberg A, Essen L, Axfors C, Blomberg O, et al. Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol. BMJ Open. 2019;9:e032659. https://doi.org/10.1136/bmjopen-2019-032659. Evans K, Rennick-Egglestone S, Cox S, Kuipers Y, Spiby H. Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis. J Med Internet Res. 2022;24. https://doi.org/10.2196/28093. Pedersen MK, Mohammadi R, Mathiasen K, Elmose M. Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients’ experience of the therapy. Scand J Psychol. 2020;61:846–54. https://doi.org/10.1111/sjop.12665. Lindegaard T, Kashoush F, Holm S, Halaj A, Berg M, Andersson G. Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a qualitative study. BMC Psychiatry. 2021;21:288. https://doi.org/10.1186/s12888-021-03297-w. Holst A, Nejati S, Björkelund C, Eriksson MCM, Hange D, Kivi M, et al. Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scand J Prim Health Care. 2017;35:46–53. https://doi.org/10.1080/02813432.2017.1288813. O’Mahen H, Fedock G, Henshaw E, Himle J, Forman J, Flynn H. Modifying CBT for Perinatal Depression: What Do Women Want? A Qualitative Study. Cogn Behav Pract - COGN BEHAV Pr. 2012;19. https://doi.org/10.1016/j.cbpra.2011.05.005. Nieminen K, Andersson G, Wijma B, Ryding E-L, Wijma K. Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study. J Psychosom Obstet Gynecol. 2016;37:37–43. https://doi.org/10.3109/0167482X.2016.1140143. Gericke F, Ebert DD, Breet E, Auerbach RP, Bantjes J. A qualitative study of university students’ experience of Internet-based CBT for depression. Couns Psychother Res. 2021;21:792–804. https://doi.org/10.1002/capr.12465. O’Mahen H, Grieve H, Jones J, McGinley J, Woodford J, Wilkinson E. Women’s experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural Activation for Postnatal Depression. Internet Interv. 2015;2:84–90. https://doi.org/10.1016/j.invent.2014.11.003. Baylis R, Ekdahl J, Haines H, Rubertsson C. Women’s experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth. Women Birth. 2020;33:e227–33. https://doi.org/10.1016/j.wombi.2019.05.006. Simon NA, Evans J, Bispham D, Williams F, Jones J, Roberts NP, et al. A Systematic Review of Factors Associated With Treatment Engagement and Outcome for Women in the Perinatal Period Receiving Individual Cognitive Behavioral Therapy (CBT) for Depression, Anxiety, and Trauma-Related Disorders. Depress Anxiety. 2025;2025:3698331. https://doi.org/10.1155/da/3698331. Johansson C, Edqvist M, Bonnevier A, Vilhelmsen M, Rubertsson C. Swedish womeńs suggestions for health care improvements during the first year after birth: A qualitative study of free-text answers given within a randomized controlled trial. Sex Reprod Healthc. 2025;44:101078. https://doi.org/10.1016/j.srhc.2025.101078. Zieß V, Seefeld L, Mojahed A, Martini J, Asselmann E, Schellong J, et al. Support preferences among women with and without postpartum depression and anxiety disorder. BMC Public Health. 2025;25. https://doi.org/10.1186/s12889-025-24274-y. Windle E, Tee H, Sabitova A, Jovanovic N, Priebe S, Carr C. Association of Patient Treatment Preference With Dropout and Clinical Outcomes in Adult Psychosocial Mental Health Interventions: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020;77:294–302. https://doi.org/10.1001/jamapsychiatry.2019.3750. Nissling L, Kraepelien M, Kaldo V, Hange D, Larsson A, Persson M, et al. Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial. Internet Interv. 2021;26:100456. https://doi.org/10.1016/j.invent.2021.100456. Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet‐delivered psychological treatments: from innovation to implementation. World Psychiatry. 2019;18:20–8. https://doi.org/10.1002/wps.20610. Pan J, Luo W, Zhang H, Wang Y, Lu H, Wang C, et al. The Effects of Online Cognitive Behavioral Therapy on Postpartum Depression: A Systematic Review and Meta-Analysis. Healthcare. 2025;13:696. https://doi.org/10.3390/healthcare13070696. Seittu HA-M, Falk T, Bhatnagar K, Saarni SE. Therapists’ Role in Patient Adherence to Internet-Based Cognitive Behavioral Therapy: Qualitative Study. J Med Internet Res. 2025;27:e71852–e71852. https://doi.org/10.2196/71852. Musiat P, Johnson C, Atkinson M, Wilksch S, Wade T. Impact of guidance on intervention adherence in computerised interventions for mental health problems: a meta-analysis. Psychol Med. 2022;52:229–40. https://doi.org/10.1017/S0033291721004621. Johansson O, Michel T, Andersson G, Paxling B. Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study. Internet Interv. 2015;2:137–42. https://doi.org/10.1016/j.invent.2015.02.006. Lawler K, Earley C, Timulak L, Enrique A, Richards D. Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study. JMIR Form Res. 2021;5:e26221. https://doi.org/10.2196/26221. Wan Mohd Yunus WMA, Matinolli H-M, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, et al. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res. 2022;24:e33337. https://doi.org/10.2196/33337. Bakanaitė R, Bakanienė I, Kanyeredzi A. Long-Term Effectiveness of Internet-Based Versus Traditional Cognitive Behavioral Therapy Across Psychiatric Disorders: A Systematic Review and Meta-Analysis. Telemed E-Health. 2025;31:1284–96. https://doi.org/10.1177/15305627251358855. Hedman E, Ljótsson B, Kaldo V, Hesser H, El Alaoui S, Kraepelien M, et al. Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care. J Affect Disord. 2014;155:49–58. https://doi.org/10.1016/j.jad.2013.10.023. Kambeitz-Ilankovic L, Rzayeva U, Völkel L, Wenzel J, Weiske J, Jessen F, et al. A systematic review of digital and face-to-face cognitive behavioral therapy for depression. Npj Digit Med. 2022;5:144. https://doi.org/10.1038/s41746-022-00677-8. Alfonsson S, Olsson E, Linderman S, Winnerhed S, Hursti T. Is online treatment adherence affected by presentation and therapist support? A randomized controlled trial. Comput Hum Behav. 2016;60:550–8. https://doi.org/10.1016/j.chb.2016.01.035. Berger M. Envy and Generosity Between Co-Therapists. Group. 2002;26:107–21. Hornova L. Dialogical Co‐therapy. Aust N Z J Fam Ther. 2021;41. https://doi.org/10.1002/anzf.1431. Hendrix CC, Fournier DG, Briggs K. Impact of Co-Therapy Teams on Client Outcomes and Therapist Training in Marriage and Family Therapy. Contemp Fam Ther. 2001;23:63–82. https://doi.org/10.1023/A:1007824216363. Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. Los Angeles: SAGE; 2013. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26:1753–60. https://doi.org/10.1177/1049732315617444. Svanborg P, Asberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994;89:21–8. https://doi.org/10.1111/j.1600-0447.1994.tb01480.x. Svanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). J Affect Disord. 2001;64:203–16. https://doi.org/10.1016/s0165-0327(00)00242-1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706qp063oa. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589–97. https://doi.org/10.1080/2159676X.2019.1628806. Braun V, Clarke V. Thematic analysis: a practical guide. Los Angeles London New Delhi Singapore Washington DC Melbourne: SAGE; 2022. Braun V, Clarke V. Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Palliat Med. 2024;38:608–16. https://doi.org/10.1177/02692163241234800. Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. Health Soc Care Community. 2019;27:e389–405. https://doi.org/10.1111/hsc.12740. Singla DR, Lawson A, Kohrt BA, Jung JW, Meng Z, Ratjen C, et al. Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021;78:498–509. https://doi.org/10.1001/jamapsychiatry.2020.4556. Sufredini F, Catling C, Zugai J, Chang S. The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review. J Affect Disord. 2022;319:119–41. https://doi.org/10.1016/j.jad.2022.09.005. Andersson G, Käll A, Juhlin S, Wahlström C, de Fine Licht E, Färdeman S, et al. Free choice of treatment content, support on demand and supervision in internet-delivered CBT for adults with depression: A randomized factorial design trial. Behav Res Ther. 2023;162:104265. https://doi.org/10.1016/j.brat.2023.104265. Kleiboer A, Donker T, Seekles W, van Straten A, Riper H, Cuijpers P. A randomized controlled trial on the role of support in Internet-based problem solving therapy for depression and anxiety. Behav Res Ther. 2015;72:63–71. https://doi.org/10.1016/j.brat.2015.06.013. Bennett CB, Toevs EK, Angus A, Krawczak R, Trentacosta CJ, Jagadeesh D, et al. Meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome: A 10-year update. Clin Psychol Rev. 2025;121:102644. https://doi.org/10.1016/j.cpr.2025.102644. Verhelst P, Sels L, Lemmens G, Verhofstadt L. The role of emotion regulation in perinatal depression and anxiety: a systematic review. BMC Psychol. 2024;12:529. https://doi.org/10.1186/s40359-024-02033-9. Akbari M, Seydavi M, Hosseini ZS, Krafft J, Levin ME. Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis. J Context Behav Sci. 2022;24:65–78. https://doi.org/10.1016/j.jcbs.2022.03.007. Kazma JM, van den Anker J, Allegaert K, Dallmann A, Ahmadzia HK. Anatomical and physiological alterations of pregnancy. J Pharmacokinet Pharmacodyn. 2020;47:271–85. https://doi.org/10.1007/s10928-020-09677-1. Ekelöf K, Tangen GA, Nyström CD, Löf M, Thomas K. Mental wellbeing during pregnancy and the transition to motherhood: an explorative study through the lens of healthcare professionals. BMC Pregnancy Childbirth. 2025;25:803. https://doi.org/10.1186/s12884-025-07894-5. Takács L, Zhang Z, Lee S, Putnam SP, Kaňková Š, Ullmann J, et al. Examining associations of temporal changes in maternal emotions and their biomarkers with the development of maternal-fetal bonding across pregnancy. Midwifery. 2025;149:104551. https://doi.org/10.1016/j.midw.2025.104551. van Scheppingen MA, Denissen JJA, Chung JM, Tambs K, Bleidorn W. Self-esteem and relationship satisfaction during the transition to motherhood. J Pers Soc Psychol. 2018;114:973–91. https://doi.org/10.5167/uzh-205994. Cuijpers P, Reijnders M, Huibers MJH. The Role of Common Factors in Psychotherapy Outcomes. Annu Rev Clin Psychol. 2019;15:207–31. https://doi.org/10.1146/annurev-clinpsy-050718-095424. Henriques G, Gralha M. The common core of psychotherapy: Bridging common factors with unification to frame the center of the field. J Psychother Integr. 2024;34:219–45. https://doi.org/10.1037/int0000345. Baier-Mosch F, Weiher GM, Kananian S. Determining what is common: A theoretical account of common factors in psychotherapy through the lens of self-determination theory. J Contemp Psychother Cut Edge Mod Dev Psychother. 2025. https://doi.org/10.1007/s10879-025-09664-y. Kaldo V, Ramnerö J, Jernelöv S. Involving clients in treatment methods: A neglected interaction in the therapeutic relationship. J Consult Clin Psychol. 2015;83:1136–41. https://doi.org/10.1037/ccp0000039. Bull E, Al-Janabi S, Gittins CB. Are women with traits of perfectionism more likely to develop perinatal depression? A systematic review and meta-analysis. J Affect Disord. 2022;296:67–78. https://doi.org/10.1016/j.jad.2021.09.028. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 23 Apr, 2026 Editor assigned by journal 20 Apr, 2026 Editor invited by journal 27 Mar, 2026 Submission checks completed at journal 25 Mar, 2026 First submitted to journal 25 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9093942","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633682520,"identity":"7245cb85-79da-4f78-a66c-38aa7d08a0c8","order_by":0,"name":"Sandra Frööjd","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYJACCSDmBzEMeCoSeIjWItkA1nKGVC0MvG0JhJXLt589eLuihkHCvL35QMHbeWkyDPyHD+DVYnAmL9nyzDEGCZkzxxIM527L4WGQSMNvlQFDjplkAxtDnYREjoEx77YKoBYeA/wO638D1PKPQQKiZQ5QC//5D/g9cwNoS2MbTEsD0GEMOfh1GNx4Y2zZ2AfUwQP0y5xjaTxsEmmEHJZjeLPhm42EBHvzMYM3Ncn2/PyHH+C3BgJAUcPABjadjRj1MMBMlOmjYBSMglEw8gAADng7IpPpWi8AAAAASUVORK5CYII=","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":true,"prefix":"","firstName":"","middleName":"","lastName":"Sandra","suffix":"jd"},{"id":633682521,"identity":"200876da-955b-470a-aa97-00c6525ef1b4","order_by":1,"name":"Ida Emilsson","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Ida","middleName":"","lastName":"Emilsson","suffix":""},{"id":633682523,"identity":"05a3c922-05ce-4cd9-994d-7bba418b8f99","order_by":2,"name":"Hanna Ulfsdottir","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Hanna","middleName":"","lastName":"Ulfsdottir","suffix":""},{"id":633682525,"identity":"bcbe808d-a008-4943-9d9d-44c42d06d3ef","order_by":3,"name":"Maude Johansson","email":"","orcid":"","institution":"Linnaeus University","correspondingAuthor":false,"prefix":"","firstName":"Maude","middleName":"","lastName":"Johansson","suffix":""},{"id":633682528,"identity":"3c880eb9-1a1b-4e2c-9aba-c68cbe8bd990","order_by":4,"name":"Erik Forsell","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Erik","middleName":"","lastName":"Forsell","suffix":""},{"id":633682531,"identity":"0a9a23d5-7c52-4afc-9e30-8f2a4e8271c8","order_by":5,"name":"Viktor Kaldo","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Viktor","middleName":"","lastName":"Kaldo","suffix":""},{"id":633682534,"identity":"c529274f-8c91-4d5c-982e-560f9b0f9b5d","order_by":6,"name":"Marie Bendix","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Bendix","suffix":""}],"badges":[],"createdAt":"2026-03-11 12:29:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9093942/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9093942/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108820111,"identity":"4d7824a7-2b97-4a35-a8d6-b53301c23216","added_by":"auto","created_at":"2026-05-08 16:40:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":291268,"visible":true,"origin":"","legend":"\u003cp\u003eStructure of the DANA internet-based CBT program for antenatal depression.\u003c/p\u003e\n\u003cp\u003eLegend: Overview of the DANA internet-based cognitive behavioural therapy (ICBT) program consisting of ten modules delivered with therapist guidance via the platform. Participants could also receive up to three optional live support sessions conducted by a separate clinician.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9093942/v1/e8723ae039a823f253aa7ddb.png"},{"id":108819944,"identity":"f1eaa27a-a14f-42ba-b53a-d5e4b50707c0","added_by":"auto","created_at":"2026-05-08 16:39:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79336,"visible":true,"origin":"","legend":"\u003cp\u003eThe overarching theme and associated themes describing participants experiences of ICBT with added live support.\u003c/p\u003e\n\u003cp\u003eLegend: The figure illustrates the overarching theme “Feeling held over a distance – the interplay of Support and Obligation” and the three themes developed through reflexive thematic analysis: (1) Seen and Supported, (2) Carrying the Weight of Demands, and (3) The Need for Individualized Tailoring.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9093942/v1/91d0c5c3118bc4606b26f036.png"},{"id":108822504,"identity":"22f45b6b-feea-4077-a465-f2dd5489d630","added_by":"auto","created_at":"2026-05-08 16:49:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":716356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9093942/v1/45a64da3-3b63-44ed-ac1a-ef6faaf16f10.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Held over a distance: A qualitative study on patients’ experiences of Internet- based cognitive behaviour therapy (ICBT) for antenatal depression with added live support sessions","fulltext":[{"header":"Background","content":"\u003cp\u003eAntenatal depression affects approximately 9% of the pregnant population in high income countries and 19% in low- and middle-income countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is associated with adverse psychological and physiological health outcomes for the mother and foetus [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Antenatal depression often remains untreated since it is often missed within the healthcare system, and access to psychological treatments remains limited [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, patients may be reluctant to seek help for fear of stigmatization, prioritize the unborn baby\u0026rsquo;s needs over their own, be concerned about being offered pharmaceutical treatment, and have practical barriers such as lack of time and childcare issues [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCognitive behavioural therapy (CBT) is a recommended first-line treatment of mild to moderate perinatal depression [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Evidence indicates that CBT is effective in reducing perinatal depressive symptoms, however, further research is needed to strengthen the evidence base and inform implementation [\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternet-based psychotherapeutic interventions offer practical advantages that may improve access and engagement, they are cost- and time-efficient and allows flexible use. Furthermore, internet-based delivery may reduce perceived stigma, thereby reducing barriers to treatment access [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therapist supported, Internet-based cognitive behavioural therapy (ICBT) has strong empirical support for treating depression in the general adult population and is as effective as face-to-face CBT [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A few studies have evaluated pregnancy-adapted ICBT programs with promising findings, but more research is needed [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen asked about their experience of participating in ICBT, both the perinatal group and the general population emphasize a sense of loneliness and feeling overwhelmed [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. While ICBT is generally appreciated, it is also described as demanding and many participants reports that they would have valued more live contact with their therapist [\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. It has been hypothesized that increased support and real-time interaction could enhance motivation and improve treatment completion [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrior studies suggest that treatment manuals may need to be adapted to the perinatal state to increase adherence and acceptability, as the participants indicate a higher level of motivation when the interventions are perceived as relevant or tailored to their needs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The perinatal group also expresses a desire for dignity, continuity and individualization in their care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and show a preference for treatments that include live contact [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Accommodating for patients' preferences in treatment can be associated with decreased dropout rates and stronger therapeutic alliance [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. It has been hypothesized that blended approaches, combining face-to-face and internet-based therapy and thereby retaining the advantages of both synchronous and asynchronous contact, will become an attractive option in the future [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdherence to ICBT varies considerably and is influenced by factors such as level of support, therapist role, and patient characteristics [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Reported reasons for lack of adherence include high workload with, and perceived complexity of the material, lack of motivation, and a mismatch between the treatment process and participants\u0026rsquo; expectations, but also more positive aspects such as improvement in symptoms leading to a perceived lack of need for continued treatment [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These challenges underscore the importance of strategies that promote sustained engagement. Our research group previously developed and tested a pregnancy-adapted ICBT treatment with text-based therapist support for antenatal depression compared to regular maternal health care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The treatment had a large effect size (Hedges g\u0026thinsp;=\u0026thinsp;1,2) and while adherence was comparable to similar interventions, there is still room for improvement [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdherence has been hypothesized to be a critical factor for achieving positive outcomes in ICBT interventions. Therapist-guided treatments have been shown to improve adherence and symptom reduction and lower attrition rates compared to unguided interventions [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45 CR46\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Qualitative research further emphasizes therapist support as essential for adherence, particularly in personalizing treatment, fostering therapeutic alliance and managing emotions [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings suggest that integrating guidance into digital interventions can improve adherence, engagement, and treatment efficacy; however, the optimal level or type of support required to maximize outcomes remains unclear [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. For example, one study found that enhanced support improved adherence without affecting outcome [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], highlighting the complexity of this relationship.\u003c/p\u003e \u003cp\u003eThe present study is a sub-study of a trial with the aim to improve adherence and address the specific needs of the perinatal population by integrating synchronous support sessions with a counsellor into therapist-guided ICBT. This blended format where the patient interacts with two clinicians may offer increased personalization and real-time interaction, however little is known about how patients experience such a treatment. Interacting with more than one clinician may introduce challenges such as coordination difficulties, higher costs, and reduced therapist decisiveness, but it could also enrich the therapeutic experience by providing diverse perspectives and stronger alliances [\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Therefore, the current study aims to explore patients\u0026rsquo; experience of therapist-guided ICBT with added synchronous support sessions provided by a clinician experienced in perinatal care, with a particular focus on perinatal support and treatment personalization. Given the limited research on the involvement of multiple clinicians in ICBT is limited, we also aim to explore patients' experiences of these aspects.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy aim\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study aims to explore the patients\u0026rsquo; experiences of enhanced support in ICBT for antenatal depression, combining traditional, written, therapist guidance from a clinical psychologist with live support sessions delivered through video, telephone or in person, by a clinician experienced in perinatal psychiatry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy design\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was a qualitative interview study, included as a sub-study in a randomized controlled trial conducted in Sweden, the DANA project. Trial registration: ClinicalTrials.gov, NCT05533138, registered 9 September 2022. The data was collected using semi-structured interviews with patients and analysed using reflexive thematic analysis. Baseline characteristics were included from self-report measures collected upon self-referral.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe DANA project\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the DANA project, individuals in pregnancy week 8-29 were recruited nationally (Sweden) via ads in social media and through maternal health care clinics. Diagnostic assessment was performed by clinicians trained in diagnostic assessment and supervised by experienced perinatal psychiatric clinicians. Assessment consisted of a structured diagnostic interview (DSM-5 for depression and M.I.N.I. for other psychiatric diagnoses) as well as mental and physical health factors associated with pregnancy. Those who fulfilled inclusion criteria after assessment (adults in pregnancy week 8-30; mild to moderate depression; ability to perform ICBT and without severe mental or physical conditions, treatment with similar psychotherapy or recent medication change) were randomized (1:1) to either receive pregnancy-adapted ICBT for depression guided by a CBT-trained therapist or the same treatment with an addition of up to three sessions with added live support sessions. Participants were blind to treatment allocation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants and recruitment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants recruited for the purpose of this study were among those that had been randomized to ICBT with the synchronous support sessions and had to have completed at least one module or one support session. A combination of criteria sampling and convenience sampling [52] was applied where all participants who were eligible for the study were asked to participate during three specific timeframes, due to practicalities (between March and April of 2023, April and May of 2024 and August 2024). In the second and third period criteria sampling was used with stratification based on responsible therapists to enable diversity. Adequate sample size was guided by information power [53] with the aim to offer new insights that can influence further development of perinatal care. \u0026nbsp;A total of 23 participants were contacted. Three declined to participate and 20 participants contributed to the qualitative study. The mean age of the included participants was 32 years. For more demographic information please see Table 1. Participants are referred to by number (e.g. P1 represents Participant 1). For confidentiality reasons, demographic details are not connected to individual participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1. Baseline characteristics and treatment engagement (n = 20).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Legend: The Montgomery-\u0026Aring;sberg Depression Rating Scale Self-report version (MADRS-S) collected at baseline was used for baseline-data. It is a widely used and validated scale for measuring depression [54, 55], with a maximum score of 54.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTreatment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe treatment protocol, without the addition of synchronous support sessions, had previously been tested in a randomized controlled trial [18]. The treatment was a guided self-help treatment consisting of a ten-week ICBT program adapted for antenatal depression. The treatment was delivered via an online platform and was structured around ten modules containing texts, assignments, and exercises. The modules addressed areas such as psychoeducation, behavioural activation, and cognitive coping strategies (see Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participant had regular asynchronous contact in the treatment platform, with a CBT-trained clinical psychologist or a final-semester psychology student under supervision, referred to as the therapist in the article. The therapist provided feedback, encouragement and support in written messages. Alongside contact with the therapist on the platform, patients were offered up to three synchronous support sessions in an integrated manner. All patients included in this study received support sessions through digital format (telephone or video). Patients played an active role in choosing how many of these sessions to use, at what point during treatment, and their content. The support was provided by a midwife, referred to as the counsellor in this article. Participants were informed that the counsellor was familiar with the content of the treatment and experienced in working with the perinatal population. They were also informed that the therapist and the counsellor communicated with each other before and after each session. The purpose of the support sessions was described as providing additional space to talk about their well-being and treatment progress. Suggested topics included common pregnancy-related difficulties, anxiety, relationship problems, and support to improve treatment adherence through e.g. individualised problem-solving strategies. To facilitate communication a worksheet was used within the platform, filled out before and after the sessions by the patient, therapist and counsellor. The therapist and counsellor could also communicate outside this format during a weekly clinical meeting, and, when needed, by phone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA qualitative semi-structured interview guide covered participants\u0026rsquo; overall treatment experiences, perceptions of the live support sessions, experiences of the dual-clinician format, unmet needs and perceived helpful components. The interview guide was continuously discussed in the research group and developed during the data collection. The interviews were performed over the telephone by two psychologists (n = 11) and two master students in clinical psychology (n = 9). All interviewers had worked as therapists within the DANA-project. One (SF, the first author) had also worked as a counsellor within the project. None had worked clinically with the participants they interviewed. The average length of the interviews was 25 minutes (range = 9 to 50 min). The interviews were audio-recorded and transcribed verbatim by the interviewer. Half of the interviews were transcribed with the help of an AI-supported transcription service (Whisper), compliant with institutional data-protection requirements. All transcripts were manually verified. Baseline characteristics were included from self-report measures collected upon self-referral.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQualitative analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData was analysed with an iterative process of mainly inductive reflexive thematic analysis [56\u0026ndash;58] using NVivo 15 software. Our reflexive thematic analysis is underpinned by a critical realist ontology. This reflects a belief that there is a pursuable reality that cannot be captured in its purest form. As our perception of reality is inevitably shaped by social context, an epistemological concern with the importance of context and a striving to find truth within this context is necessary [58]. Reflexive thematic analysis was chosen because it provides an accessible and flexible method which gives an opportunity for the data analysis to be both inductive and/or iterative as well as having an experiential semantic approach within a pragmatic paradigm [58].\u003c/p\u003e\n\u003cp\u003eThe Reflexive Thematic Analysis Reporting Guidelines (RTARG) have been used as a guide when designing, executing, and writing this article [59]. SF and IE read the transcripts several times to get familiarized with the data, creating written reflections during this process. Initial codes were then generated line-by-line. SF performed most of the initial rigorous coding, with assistance from IE. Codes, as well as themes, were created in an iterative process in search of common meanings, with the use of movable notes to aid in this process. Discussions were held on several occasions in the research group with an aim to reach consensus without ignoring how the analysis and the themes were developed. SF then returned to the data to re-evaluate. Thereafter, themes were defined and named to verbalize their content, and the manuscript was written, including citations to illustrate the analysis. Interview quotes were translated from Swedish to English for reporting purposes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eReflexivity\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe research group maintained a continuous reflexive stance throughout the analysis process. Through ongoing journalling and regular discussions, we examined how our own backgrounds and experiences, such as lived experience of perinatal depression and our roles as both developers and therapists of the treatment being evaluated, may have shaped our conceptualization of the study as well as our interpretations of the data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFeeling held over a distance \u0026ndash; The Interplay of Support and Obligation\u003c/p\u003e \u003cp\u003eThe experiences of the participants were summarized into one overarching theme, including\u003c/p\u003e \u003cp\u003ethree major themes (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Participants described the treatment as a whole to be one where they felt genuinely seen and supported, and where many elements were perceived as helpful. They highlighted the value of the therapeutic relationship with the therapist and the counsellor, the relevance of the written modules, and the validating nature of the treatment. At the same time, the participants experienced the treatment as demanding, and they expressed a strong wish for personal tailoring of both the pacing and of the components of the treatment including the amount and format of materials.\u003c/p\u003e \u003cp\u003eThe synchronous support sessions were a valued part of the treatment, offering opportunities for individualised guidance and contributing to a deeper therapeutic relationship. While participants clearly expressed a need for further adaptation, their accounts also reflect the complexity of optimizing psychological treatments.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLegend: The figure illustrates the overarching theme \u0026ldquo;Feeling held over a distance \u0026ndash; the interplay of Support and Obligation\u0026rdquo; and the three themes developed through reflexive thematic analysis: (1) Seen and Supported, (2) Carrying the Weight of Demands, and (3) The Need for Individualized Tailoring.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSeen and supported\u003c/h2\u003e \u003cp\u003eThis theme captures participants\u0026rsquo; experiences of feeling emotionally acknowledged and supported throughout the treatment. The accounts reflect how therapeutic presence, relational aspects, and personalization across the treatment as a whole contributed to a sense of being seen, validated, and emotionally held.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The best part, overall, in the whole treatment, was the amazing way I was met. That I got to just be who I am\u0026hellip; Because I feel that the experience in healthcare sometimes can be that you\u0026rsquo;re not feeling well, they prescribe antidepressants, and then they kind of lose track of you. And that wasn\u0026rsquo;t the experience here at all, so I think that\u0026rsquo;s something that should really be implemented much more. That there\u0026rsquo;s a red thread, and that no one just drops you and goes \u0026ldquo;bye, take care.\u0026rdquo; Instead, you feel cared for and important.\u0026rdquo; (P1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMost participants expressed appreciation for the treatment, highlighting the value of its content, the support from the therapist and the counsellor, and the overall format. They described the intervention as helpful and reported having acquired knowledge and strategies that they continued to use after the treatment. They described the modules as relevant, personalized, and supportive in relation to pregnancy and expressed that participation facilitated help-seeking in other areas of healthcare.\u003c/p\u003e \u003cp\u003eThey also described how the treatment became part of a broader process, leading to a deeper understanding of themselves and their needs, including the realization that they were depressed and identifying factors that had contributed to it.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I really felt that the treatment helped me \u0026ndash; or, well, probably everything did, the whole package\u0026rdquo;. (P2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants repeatedly described the experience of the contact with the therapist and the counsellor as a relationship where they felt seen, normalized, treated with warmth, and met in their struggles. The supportive approach from both the therapist and the counsellor was described as helpful in navigating the treatment and maintaining motivation during more difficult periods.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When you were feeling the way you were, there was a lot to take in, and I had to rely a lot on support from the therapist, to get\u0026hellip; yeah, I couldn\u0026rsquo;t sit and read through the module, it was too much for me\u0026rdquo;. (P3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSeveral participants stressed the importance of how the treatment helped to normalize their experiences. Feelings of shame about not being \u0026ldquo;just happy\u0026rdquo; during this period were commonly described, and the way these feelings were acknowledged and met within the treatment as a whole helped to relieve some of the shame and guilt that the participants often experienced.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The support call could still confirm for me that it\u0026rsquo;s completely normal. Well, not normal, but it\u0026rsquo;s okay to feel bad. You don\u0026rsquo;t have to be happy just because you\u0026rsquo;re pregnant.\" (P4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe participants also expressed an appreciation of being able to use the treatment as a space where they could express things that they feared saying in their day-to-day life.\u003c/p\u003e \u003cp\u003eMany of the participants expressed appreciation for communicating through live conversations during the support sessions. They described how synchronous contact contributed to a deeper and more emotionally accessible therapeutic relationship. Some also raised how spoken conversation, as opposed to written communication, made it harder to remain detached from the content, evoking stronger emotional responses, which they perceived as beneficial for the therapeutic process. The format of the support sessions provided a space to talk things through, fostering a sense of safety, while also allowing for real-time feedback and reflection. The immediacy of the communication enabled follow-up questions and a sense of reciprocity, which were highly valued by several participants. These aspects appeared to contribute to building a stronger therapeutic alliance.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think it became easier for both parties to ask follow-up questions in a direct conversation. Sure, I could get good feedback via text as well. But I probably preferred what I got over the phone. Because it was, well, a bit more detailed, more back-and-forth reasoning, I think.\u0026rdquo; (P4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA common viewpoint was that the synchronous support sessions were the most appreciated part of the treatment, and many of the participants felt that these sessions made a great difference to their mental well-being.\u003c/p\u003e \u003cp\u003eWhile many participants emphasized the value of synchronous support contact, some also appreciated the sense of anonymity provided by the platform. The asynchronous format enabled openness regarding thoughts and feelings that were difficult to express in everyday life.\u003c/p\u003e \u003cp\u003eThe treatments' dual clinician format elicited mixed experiences among participants, with challenges related to it explored in a subsequent theme. Some of the participants described this treatment format as highly beneficial, enhancing the sense of being emotionally supported, and providing an opportunity to gain additional perspectives on the issues they were struggling with.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;To get confirmation from several people, for someone like me who has very high demands, I can very easily dismiss it if it\u0026rsquo;s just \u0026lsquo;one person\u0026rsquo; saying something, but if two people say similar things, then you can think, well okay, this probably makes sense.\u0026rdquo; (P5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOverall, these accounts suggest that the experience of \u0026lsquo;being seen and held\u0026rsquo; can serve as an emotional support that reduces shame, fosters self-acceptance, and sustains motivation to engage in treatment. Participants experienced support through the treatment content, the platform text, and through direct conversations. The synchronous support sessions were described as enriching the relationship, offering a depth that was especially appreciated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCarrying the Weight of Demands\u003c/h2\u003e \u003cp\u003eAlmost all participants described how demands from various sources affected them. They highlighted that the treatment itself was, in many ways, experienced as demanding, sometimes to the extent that they lacked the energy to complete all components. They also described external and self-imposed demands as unhelpful when trying to engage with the treatment.\u003c/p\u003e \u003cp\u003eParticipants generally perceived the ICBT treatment as demanding. The modular format was experienced as challenging, primarily due to the extensive amount of text and the complexity of some of the assignments. Many also described the treatment as intense in terms of pace, which contributed to it being experienced as time-consuming. Combined with symptoms of depression, the treatment could feel overwhelming and burdensome.\u003c/p\u003e \u003cp\u003e\u0026ldquo;...\u003cem\u003eit felt like the treatment itself also became a demand\u003c/em\u003e.\u0026rdquo; (P6)\u003c/p\u003e \u003cp\u003eOther aspects of the treatment structure that were described as challenging by some of the participants included the dual-therapist model. Participants mentioned having to repeat themselves, the potential for misunderstandings, and the emotional effort required to build relationships with two clinicians instead of one. Some found this setup confusing, fragmented, and unnecessary. Those who expressed such concern often preferred having one consistent therapist who could provide both the structured ICBT and the support sessions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It could be good for it to be the same person because that means you\u0026rsquo;ll feel closer to that one person\u0026hellip; and like\u0026hellip; [the therapist] definitely knew... more about what was happening with me day to day and so then expanding on that with her could be good... or like... you know having a video call with her could be good.\u0026rdquo; (P7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSeveral participants described a lack of energy or motivation to fully engage with the treatment, often due to the demands of their everyday lives. They explained how life \u0026ldquo;came between\u0026rdquo; them and the treatment, listing how full-time work or studies, family responsibilities, or moving house, consumed all their time and made it impossible for them to focus on the treatment. Some participants also noted that pregnancy, and the emotional and physical demands that came with it, limited their ability to participate in the treatment. Concerns about the course of the pregnancy or fears of a potential preterm birth shifted their focus and made the treatment feel less relevant or urgent.\u003c/p\u003e \u003cp\u003eSeveral participants repeatedly spoke about self-imposed demands. They described placing high expectations on themselves and a perfectionist side, which seemed to undermine their capacity to engage meaningfully with the treatment. This perfectionist tendency appeared to reduce participants\u0026rsquo; tolerance for partial engagement or imperfection in their treatment efforts.\u003c/p\u003e \u003cp\u003eMany experienced heavy workloads and feelings of inadequacy and had questions that they never raised with their therapist or the counsellor. This appeared not to reflect a lack of trust in the clinicians, but rather a lack of ability to ask for help or request adjustments. A recurring mindset emerged: \"\u003cem\u003eeither I do it all, or I do nothing\u003c/em\u003e\", which often led to decreased engagement. P8\u0026acute;s account illustrates how stress and self-imposed pressure can interfere with prioritizing treatment even when the need for support is acknowledged.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eYes, but it was a bit harder to\u0026hellip; Well, especially when you\u0026rsquo;re feeling bad yourself and it depends on you and taking the time and prioritizing it. I thought it was difficult because I was also very stressed during that period\u003c/em\u003e.\u0026rdquo; (P8)\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; experiences revealed a conflict between the structured demands of the ICBT treatment and the unpredictable, often overwhelming nature of their daily lives. This mismatch appeared to create barriers to sustained engagement, particularly when life circumstances competed for time and emotional resources. Self-imposed expectations and perfectionist tendencies further complicated participation, with some describing an all-or-nothing mindset that hindered flexibility. Together, these findings highlight the need for tailoring of workload and pacing, even within structured digital interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe need for individualized tailoring\u003c/h2\u003e \u003cp\u003eThis theme addresses the recurring mentions of the need for individualization. Participants wanted more time and flexibility; the fast pace sometimes caused them to rush through the material, negatively affecting both their engagement and the potential benefits. Many appreciated the idea of a longer treatment period to reduce time pressure and a reduction in the reading material.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think it would have been easier if the reading hadn\u0026rsquo;t felt so heavy. Maybe if it had been shorter, with more modules instead, more broken down into smaller parts.\u0026rdquo;\u003c/em\u003e (P2)\u003c/p\u003e \u003cp\u003eA few participants also expressed that they would have wanted more live contact or more support sessions during their treatment period.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I probably needed, like, more frequent, more conversational contact.\u0026rdquo; (P3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome participants requested alternative formats, like having the material read aloud or presented through video. Participants also emphasized the importance of technical simplicity and accessibility. When experiencing mental distress, they described having limited capacity to troubleshoot or navigate complex systems, underscoring the need for a treatment that is easy to use and free from technical issues.\u003c/p\u003e \u003cp\u003eWhile support sessions were appreciated as a form of adaptation, participants also noted that the interactions could be further tailored to better address individual emotional and contextual needs. Some participants wished for more structure, addressing how that could have improved their engagement with the treatment during the treatment period as well as after.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMaybe a bit more support on how to review, like different parts, would have been good, because not that much gets done now\u003c/em\u003e.\u0026rdquo; (P10)\u003c/p\u003e \u003cp\u003eThe participants appreciated being guided by the therapist, for example, when the therapist identified moments where they seemed stuck and suggested topics that could be discussed during their session with the counsellor. This proactive guidance was experienced as valuable, helping to make use of the treatment more effectively.\u003c/p\u003e \u003cp\u003eThe therapist and the counsellors\u0026rsquo; distinct professional roles were perceived as enriching, as it allowed for multiple perspectives and different ways of relating to oneself. It was also considered helpful to raise different topics with each clinician, depending on their respective area of expertise [psychologist or midwife with psychiatric competence]. The support sessions were often used to address concerns that lay outside the core treatment content, such as anxiety related to pregnancy and other concerns revolving around pregnancy and childbirth. Addressing different types of issues with the therapist and the counsellor also helped clarify their individual roles, which some participants felt reduced confusion.\u003c/p\u003e \u003cp\u003eMany valued the flexibility that ICBT offers. The ability to make choices regarding when and how to engage with the treatment was described as fostering a sense of autonomy and control. Participants appreciated the person-centred adaptations included in the treatment, for example being able to select the later modules and influence the timing and content of support sessions, which contributed to a more personalized experience. However, the fixed nature of the program content \u0026ndash; especially in text format \u0026ndash; was sometimes seen as rigid and not always aligned with participants\u0026rsquo; needs or preferences. This rigidity was seen as a barrier to engagement, especially when the material felt irrelevant or too simplistic.\u003c/p\u003e \u003cp\u003eOverall, participants\u0026rsquo; accounts underscore the importance of a treatment that is not only structured and supportive but also responsive to individual needs and preferences. The analysis highlighted the importance of the clinicians\u0026rsquo; active role in tailoring suggestions and guidance to each participants\u0026rsquo; specific concerns.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe participants\u0026rsquo; experiences indicate that therapist-guided ICBT with added synchronous support by a clinician other than the therapist is an appreciated treatment option, where the support sessions are viewed as an opportunity for discussions that are more in-depth. Participants often experience a high level of burden, both related to treatment and to other areas of life. This has an impact on the feasibility of the treatment and should be acknowledged both during implementation and, more broadly, in settings where perinatal care is delivered. Interacting with two clinicians provided a possibility to gain perspectives from different professions but was sometimes perceived as hindering.\u003c/p\u003e \u003cp\u003ePrevious research shows that perinatal populations value personal tailoring [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], which our findings support. Some participants noted that support sessions could feel burdensome, and preferences varied regarding the timing and amount of support. This draws attention to the importance of flexibility in both timing and frequency, and of assessing individual needs to ensure that the right level of support is offered. Together, these findings highlight not only a strong appreciation for support, but also considerable variation in how and when such support is experienced as helpful.\u003c/p\u003e \u003cp\u003eThe lack of energy and motivation described by many participants may reflect core symptoms of depression and seems to impair the engagement in the treatment. External factors such as childcare responsibilities and workload also affected participants\u0026rsquo; ability to fully engage.\u003c/p\u003e \u003cp\u003eIn this study the participants consistently described the support sessions as helpful and appreciated. Evidence on symptom reduction through support sessions is limited [\u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] but our participants\u0026rsquo; accounts suggest that the sessions were valued and provided a sense of being \u0026ldquo;held\u0026rdquo; during a vulnerable period, which may contribute to well-being beyond lower levels of depressive symptoms.\u003c/p\u003e \u003cp\u003eThe support sessions were delivered through video or telephone rather than the asynchronous written messages from the regular therapist, and it is unclear whether it would have been perceived as equally helpful if provided by the therapist instead of the counsellor. Several participants indicated that they would have preferred having the same person for both types of contact.\u003c/p\u003e \u003cp\u003ePatients often wish for more direct contact [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and participants\u0026rsquo; positive views of the support sessions may reflect the value of personal interaction rather than the involvement of an additional clinician. In this context, the support sessions are intertwined with the value of synchronous contact, making it difficult to disentangle the importance of extra interaction from that of increased immediacy.\u003c/p\u003e \u003cp\u003eInterestingly, although participants received more support than is typical in ICBT, some still wished for additional contact. At the same time, many did not utilise all available sessions., highlighting the gap between expressed preference and actual use. This pattern is in line with findings from the ICBT literature indicating that when support is provided on demand, it is often used less frequently than scheduled support [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], despite participants expressing a desire for greater therapist contact. This apparent discrepancy underscores the importance of distinguishing between expressed preferences for support and mechanisms that contribute to therapeutic change. Wanting more or individualized support does not necessarily mean that more support will be utilized, nor that it is an effective mechanism of change and leads to improved treatment outcomes. Psychotherapy research suggests that perceived helpfulness and client preferences are often associated with engagement and satisfaction. However, these factors do not consistently correspond to clinical efficacy [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Such preferences may also reflect distress or discomfort with challenging treatment components or social interactions. In some cases, they may function as strategies to avoid emotionally demanding tasks [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere may also be patients that wish for none or low levels of support that might have benefited from higher levels.\u003c/p\u003e \u003cp\u003eThe distinction between preferences, engagement, and mechanism of change may be particularly relevant in pregnancy, a period characterized by substantial emotional, relational, and physiological change [\u003cspan additionalcitationids=\"CR69 CR70\" citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. Even though guided interventions show superior outcomes compared to self-guided formats, this does not indicate a simple dose\u0026ndash;response relationship between the amount of therapist contacts and treatment effectiveness [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Rather, the relevance and integration of support within a structured intervention appear more important than its quantity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Support that feels meaningful and well-integrated into the treatment framework may enhance engagement more effectively than simply increasing the number of interactions. Further research is needed to clarify under which conditions and for whom additional support enhances engagement in active treatment components and improves outcomes.\u003c/p\u003e \u003cp\u003eBeyond the amount of support provided, the quality and relational aspects of support may play a central role in how digital interventions are experienced. The theme \u003cem\u003e\u0026ldquo;Seen and Supported\u0026rdquo;\u003c/em\u003e reflects what psychotherapy research often describes as a common factor: the therapeutic relationship that fosters hope and healing [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. In the literature, such relational elements are considered part of therapy\u0026rsquo;s shared core [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e] and techniques that may optimize the change process [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Given the challenges of establishing causality, it remains uncertain whether therapeutic effects are driven primarily by common or specific factors, or by an interplay of both [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The latter have been demonstrated in one study, where the effect of adding therapist support to a self-help intervention was shown to improve outcome mainly through increasing the adherence to the most effective, but also most demanding, techniques [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. However, from the participants perspective in this study, feeling acknowledged and validated emerged as central. They described how the support from the therapist and the counsellor contributed to a sense of warmth and recognition.\u003c/p\u003e \u003cp\u003eHow these relational elements are perceived and utilized may vary across subgroups within the perinatal population. Prior evidence links perfectionism to perinatal depression [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e] and our findings echo this tendency. Some participants reflected on high self-expectations that affected engagement and that they often did not voice during treatment. The treatment often reaches highly educated, full-time working expecting mothers experiencing depression, for whom self-imposed demands may be particularly influential. Consequently, interventions may need to be even more clearly tailored for this group, ensuring that content and delivery align with their specific circumstances.\u003c/p\u003e \u003cp\u003eAt the same time, these findings invite reflection on the limits of individual tailoring in digital interventions. Increased flexibility may not always improve outcomes and may add complexity or pressure to an already vulnerable situation, as well as increasing resource demands. Further research is needed to clarify when additional support enhances engagement and outcomes, and when it may increase strain.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eSome limitations of this study must be noted. Firstly, the interviews were performed over the telephone, where non-verbal communication is weakened, which might have reduced the opportunities for follow-up questions and deeper understanding. Secondly, since the interview used a semi-structured interview guide, there is a risk that the participants' free narrative was restricted if the guide steered the conversation too rigidly. Thirdly, there is always a risk that participants answer in ways they believe are expected; however, the diversity of responses, including both positive and negative experiences, suggests that they felt safe expressing themselves. A fourth limitation is that interviews were conducted only with participants who chose to take part in at least one support session. Those who participated in the treatment but declined the support sessions were not reached. Gaining insight into the experiences of individuals who actively opt out of support sessions is likely a valuable perspective for informing future improvements in clinical care.\u003c/p\u003e \u003cp\u003eA key strength of this study is the use of semi structured interviews with a relatively large qualitative sample, allowing for rich and nuanced exploration of participants\u0026rsquo; experiences of ICBT during pregnancy. The qualitative design enabled an in-depth understanding of how treatment was perceived and integrated into participants\u0026rsquo; everyday lives, providing clinically relevant insights. In the DANA project we will also have the opportunity to examine how additional support through support sessions impacts adherence, depression severity and satisfaction.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eParticipants in therapist-guided ICBT for antenatal depression with added live support sessions by a clinician other than the therapist express an appreciation for the treatment, but also report a high level of burden, which may influence perceived feasibility. Participants expressed a clear desire for personal tailoring of structure as well as content in the treatment. These findings can be used to further refine the treatment of antenatal depression and, more broadly, interventions offered during the perinatal period.\u003c/p\u003e \u003cp\u003eThe experience of feeling seen was repeatedly emphasised as a valued aspect, both within the text-based content and in interactions with the counsellor through video or telephone. This finding displays the potential for at least some common factors to be communicated within asynchronous contexts, challenging assumptions about their dependence on real-time interaction.\u003c/p\u003e \u003cp\u003eWhile participants expressed a need for further adaptation and more contact, their accounts also reflect the complexity of optimizing psychological treatments. It remains unclear whether more tailoring would necessarily improve their experience of the treatment further, or whether it might add further complexity to an already challenging process.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCBT - Cognitive behaviour therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICBT - Internet-based cognitive behaviour therapy\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki guidelines and regulations. Ethical approval was obtained from the Swedish Ethical Review Authority (original approval Dnr. 2020-06049, amendments Dnr. 2022-04575-02 and Dnr 2024-00796-02). Digital informed consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants signed a digital consent form that included a statement for agreement to use their data for publication purposes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnonymised qualitative data can be made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by Söderström Königska Foundation (SLS-941378, SLS-941098, SLS-969514, SLS-982400, SLS-982143, SLS-995658), FORTE (2021-00867), Bror Gadelius Memory Foundation (129900957728, 129900529626), Allmänna BB Minnesfond (FoUI-1012658), Thuring Foundation (2020-00627, 2021-00692, 2022-00746, 2023-021), KI (FS-2024-0017) and The Swedish Society of Medicine, SMM (SLS-1023187, SLS-1023020). No sponsor took any part in the design, execution, analysis, interpretation or publishing decisions of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSF: Writing – original draft, Writing – review \u0026amp; editing, Visualization, Validation, Methodology, Investigation, Project administration, Formal analysis, Data curation, Conceptualization.\u003c/p\u003e\n\u003cp\u003eIE: Writing – review \u0026amp; editing, Investigation, Validation, Project administration, Methodology, Investigation, Formal analysis, Data curation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHU: Writing – review \u0026amp; editing, Validation, Supervision, Methodology, Formal analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMJ: Writing – review \u0026amp; editing, Methodology, Formal analysis, Validation, Supervision.\u003c/p\u003e\n\u003cp\u003eEF: Writing – review \u0026amp; editing, Resources, Methodology, Funding acquisition, Supervision.\u003c/p\u003e\n\u003cp\u003eVK: Writing – review \u0026amp; editing, Supervision, Resources, Methodology, Investigation, Funding acquisition, Conceptualization.\u003c/p\u003e\n\u003cp\u003eMB: Writing – review \u0026amp; editing, Validation, Data curation, Project administration, Funding acquisition, Resources, Supervision, Investigation, Conceptualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are very grateful, and would like to acknowledge, the study participants who contributed to the interviews. We would also like to thank Mona Azami Naeini and Malin Österberg for their excellent contribution in conducting a part of the interviews and participating in the development of the interview guide. We thank Petra-Sara Falk, Eva-Marie Nordenadler, Peter Lindhamre, Philippa Karlsson, Emelie Svanerud George, Kristin Öster, Malin Wiman, Sarah Ericsson and Athina Katramadou for all their work within the treatment and the study, and we would also like to acknowledge all participating student therapists. Lastly, we thank the Consultation–Liaison Unit at Psychiatry Southwest, who made the execution and implementation of ICBT for antenatal depression possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSF is a clinical psychologist and PhD student. IE is a clinical psychologist. HU is a midwife, an associate professor, and holds a PhD. MJ is an associate professor, specialist in clinical psychology and holds a PhD. MB is a perinatal psychiatrist and holds a PhD, VK is a psychologist and a professor of clinical psychology. EF is a clinical psychologist and a postdoc.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWoody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86\u0026ndash;92. https://doi.org/10.1016/j.jad.2017.05.003.\u003c/li\u003e\n \u003cli\u003eHoward LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020;19:313\u0026ndash;27. https://doi.org/10.1002/wps.20769.\u003c/li\u003e\n \u003cli\u003eMcNicholas E, Boama-Nyarko E, Julce C, Nunes AP, Flahive J, Byatt N, et al. Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History. J Womens Health 2002. 2023;32:1111\u0026ndash;9. https://doi.org/10.1089/jwh.2022.0306.\u003c/li\u003e\n \u003cli\u003eSambrook Smith M, Lawrence V, Sadler E, Easter A. Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ Open. 2019;9:e024803. https://doi.org/10.1136/bmjopen-2018-024803.\u003c/li\u003e\n \u003cli\u003eD\u0026auml;hn D, Rudolf S, Pawils S, Renneberg B. Perinatal mental health literacy: knowledge, attitudes, and help-seeking among perinatal women and the public \u0026ndash; a systematic review. BMC Pregnancy Childbirth. 2022;22. https://doi.org/10.1186/s12884-022-04865-y.\u003c/li\u003e\n \u003cli\u003eGoodman JH. Women\u0026rsquo;s Attitudes, Preferences, and Perceived Barriers to Treatment for Perinatal Depression. Birth. 2009;36:60\u0026ndash;9. https://doi.org/10.1111/j.1523-536X.2008.00296.x.\u003c/li\u003e\n \u003cli\u003eWestgate V, Manchanda T, Maxwell M. Women\u0026rsquo;s experiences of care and treatment preferences for perinatal depression: a systematic review. Arch Womens Ment Health. 2023;26:311\u0026ndash;9. https://doi.org/10.1007/s00737-023-01318-z.\u003c/li\u003e\n \u003cli\u003eSummary of the clinical practice guideline for the treatment of depression across three age cohorts. Am Psychol. 2022;77:770\u0026ndash;80. https://doi.org/10.1037/amp0000904.\u003c/li\u003e\n \u003cli\u003eHealth N, Howard T, Pilling S, Adams H, Barlow J, Bavetta M, et al. CG45 Antenatal and Postnatal Mental Health\u0026mdash;The NICE Guideline on Clinical Management and Service Guidance. 2014.\u003c/li\u003e\n \u003cli\u003ePettman D, O\u0026rsquo;Mahen H, Blomberg O, Svanberg A, Essen L, Woodford J. Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression: a systematic review and meta-analysis. BMC Psychiatry. 2023;23. https://doi.org/10.1186/s12888-023-04547-9.\u003c/li\u003e\n \u003cli\u003eLi X, Laplante DP, Paquin V, Lafortune S, Elgbeili G, King S. Effectiveness of cognitive behavioral therapy for perinatal maternal depression, anxiety and stress: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev. 2022;92:102129. https://doi.org/10.1016/j.cpr.2022.102129.\u003c/li\u003e\n \u003cli\u003eSmith RD, Dang W, Shen S, Hung SC, Lam IH, Kwok JYY, et al. Comparative effectiveness of interventions for the prevention and treatment of perinatal depression: A systematic review and network meta-analysis. Asian J Psychiatry. 2025;103:104316. https://doi.org/10.1016/j.ajp.2024.104316.\u003c/li\u003e\n \u003cli\u003eWaqas A, Zafar SW, Akhtar P, Naveed S, Rahman A. Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis. Camb Prisms Glob Ment Health. 2023;10:e22. https://doi.org/10.1017/gmh.2023.8.\u003c/li\u003e\n \u003cli\u003eShortis E, Warrington D, Whittaker P. The efficacy of cognitive behavioral therapy for the treatment of antenatal depression: A systematic review. J Affect Disord. 2020;272:485\u0026ndash;95. https://doi.org/10.1016/j.jad.2020.03.067.\u003c/li\u003e\n \u003cli\u003eCuijpers P, Riper H. Internet interventions for depressive disorders: An overview. Rev Psicopatolog\u0026iacute;a Psicol Cl\u0026iacute;nica. 2014;19:209\u0026ndash;16. https://doi.org/10.5944/rppc.vol.19.num.3.2014.13902.\u003c/li\u003e\n \u003cli\u003eCarlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerl\u0026ouml;f E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther. 2018;47:1\u0026ndash;18. https://doi.org/10.1080/16506073.2017.1401115.\u003c/li\u003e\n \u003cli\u003eHagi K, Kurokawa S, Takamiya A, Fujikawa M, Kinoshita S, Iizuka M, et al. Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry. 223:407\u0026ndash;14. https://doi.org/10.1192/bjp.2023.86.\u003c/li\u003e\n \u003cli\u003eForsell E, Bendix M, Holl\u0026auml;ndare F, Szymanska von Schultz B, Nasiell J, Blomdahl-Wetterholm M, et al. Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial. J Affect Disord. 2017;221:56\u0026ndash;64. https://doi.org/10.1016/j.jad.2017.06.013.\u003c/li\u003e\n \u003cli\u003eAshford MT, Olander EK, Ayers S. Computer- or web-based interventions for perinatal mental health: A systematic review. J Affect Disord. 2016;197:134\u0026ndash;46. https://doi.org/10.1016/j.jad.2016.02.057.\u003c/li\u003e\n \u003cli\u003eLoughnan SA, Joubert AE, Grierson A, Andrews G, Newby JM. Internet-delivered psychological interventions for clinical anxiety and depression in perinatal women: a systematic review and meta-analysis. Arch Womens Ment Health. 2019;22:737\u0026ndash;50. https://doi.org/10.1007/s00737-019-00961-9.\u003c/li\u003e\n \u003cli\u003eCanfield SM, Canada KE. Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations. J Perinat Neonatal Nurs. 2023;37:14. https://doi.org/10.1097/JPN.0000000000000658.\u003c/li\u003e\n \u003cli\u003eMassoudi P, Str\u0026ouml;mwall LA, \u0026Aring;hlen J, K\u0026auml;rrman Fredriksson M, Dencker A, Andersson E. Women\u0026rsquo;s experiences of psychological treatment and psychosocial interventions for postpartum depression: a qualitative systematic review and meta-synthesis. BMC Womens Health. 2023;23:604. https://doi.org/10.1186/s12905-023-02772-8.\u003c/li\u003e\n \u003cli\u003ePettman D, O\u0026rsquo;Mahen H, Svanberg A, Essen L, Axfors C, Blomberg O, et al. Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol. BMJ Open. 2019;9:e032659. https://doi.org/10.1136/bmjopen-2019-032659.\u003c/li\u003e\n \u003cli\u003eEvans K, Rennick-Egglestone S, Cox S, Kuipers Y, Spiby H. Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis. J Med Internet Res. 2022;24. https://doi.org/10.2196/28093.\u003c/li\u003e\n \u003cli\u003ePedersen MK, Mohammadi R, Mathiasen K, Elmose M. Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients\u0026rsquo; experience of the therapy. Scand J Psychol. 2020;61:846\u0026ndash;54. https://doi.org/10.1111/sjop.12665.\u003c/li\u003e\n \u003cli\u003eLindegaard T, Kashoush F, Holm S, Halaj A, Berg M, Andersson G. Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a qualitative study. BMC Psychiatry. 2021;21:288. https://doi.org/10.1186/s12888-021-03297-w.\u003c/li\u003e\n \u003cli\u003eHolst A, Nejati S, Bj\u0026ouml;rkelund C, Eriksson MCM, Hange D, Kivi M, et al. Patients\u0026rsquo; experiences of a computerised self-help program for treating depression \u0026ndash; a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scand J Prim Health Care. 2017;35:46\u0026ndash;53. https://doi.org/10.1080/02813432.2017.1288813.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Mahen H, Fedock G, Henshaw E, Himle J, Forman J, Flynn H. Modifying CBT for Perinatal Depression: What Do Women Want? A Qualitative Study. Cogn Behav Pract - COGN BEHAV Pr. 2012;19. https://doi.org/10.1016/j.cbpra.2011.05.005.\u003c/li\u003e\n \u003cli\u003eNieminen K, Andersson G, Wijma B, Ryding E-L, Wijma K. Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study. J Psychosom Obstet Gynecol. 2016;37:37\u0026ndash;43. https://doi.org/10.3109/0167482X.2016.1140143.\u003c/li\u003e\n \u003cli\u003eGericke F, Ebert DD, Breet E, Auerbach RP, Bantjes J. A qualitative study of university students\u0026rsquo; experience of Internet-based CBT for depression. Couns Psychother Res. 2021;21:792\u0026ndash;804. https://doi.org/10.1002/capr.12465.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Mahen H, Grieve H, Jones J, McGinley J, Woodford J, Wilkinson E. Women\u0026rsquo;s experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural Activation for Postnatal Depression. Internet Interv. 2015;2:84\u0026ndash;90. https://doi.org/10.1016/j.invent.2014.11.003.\u003c/li\u003e\n \u003cli\u003eBaylis R, Ekdahl J, Haines H, Rubertsson C. Women\u0026rsquo;s experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth. Women Birth. 2020;33:e227\u0026ndash;33. https://doi.org/10.1016/j.wombi.2019.05.006.\u003c/li\u003e\n \u003cli\u003eSimon NA, Evans J, Bispham D, Williams F, Jones J, Roberts NP, et al. A Systematic Review of Factors Associated With Treatment Engagement and Outcome for Women in the Perinatal Period Receiving Individual Cognitive Behavioral Therapy (CBT) for Depression, Anxiety, and Trauma-Related Disorders. Depress Anxiety. 2025;2025:3698331. https://doi.org/10.1155/da/3698331.\u003c/li\u003e\n \u003cli\u003eJohansson C, Edqvist M, Bonnevier A, Vilhelmsen M, Rubertsson C. Swedish womeńs suggestions for health care improvements during the first year after birth: A qualitative study of free-text answers given within a randomized controlled trial. Sex Reprod Healthc. 2025;44:101078. https://doi.org/10.1016/j.srhc.2025.101078.\u003c/li\u003e\n \u003cli\u003eZie\u0026szlig; V, Seefeld L, Mojahed A, Martini J, Asselmann E, Schellong J, et al. Support preferences among women with and without postpartum depression and anxiety disorder. BMC Public Health. 2025;25. https://doi.org/10.1186/s12889-025-24274-y.\u003c/li\u003e\n \u003cli\u003eWindle E, Tee H, Sabitova A, Jovanovic N, Priebe S, Carr C. Association of Patient Treatment Preference With Dropout and Clinical Outcomes in Adult Psychosocial Mental Health Interventions: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020;77:294\u0026ndash;302. https://doi.org/10.1001/jamapsychiatry.2019.3750.\u003c/li\u003e\n \u003cli\u003eNissling L, Kraepelien M, Kaldo V, Hange D, Larsson A, Persson M, et al. Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial. Internet Interv. 2021;26:100456. https://doi.org/10.1016/j.invent.2021.100456.\u003c/li\u003e\n \u003cli\u003eAndersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet‐delivered psychological treatments: from innovation to implementation. World Psychiatry. 2019;18:20\u0026ndash;8. https://doi.org/10.1002/wps.20610.\u003c/li\u003e\n \u003cli\u003ePan J, Luo W, Zhang H, Wang Y, Lu H, Wang C, et al. The Effects of Online Cognitive Behavioral Therapy on Postpartum Depression: A Systematic Review and Meta-Analysis. Healthcare. 2025;13:696. https://doi.org/10.3390/healthcare13070696.\u003c/li\u003e\n \u003cli\u003eSeittu HA-M, Falk T, Bhatnagar K, Saarni SE. Therapists\u0026rsquo; Role in Patient Adherence to Internet-Based Cognitive Behavioral Therapy: Qualitative Study. J Med Internet Res. 2025;27:e71852\u0026ndash;e71852. https://doi.org/10.2196/71852.\u003c/li\u003e\n \u003cli\u003eMusiat P, Johnson C, Atkinson M, Wilksch S, Wade T. Impact of guidance on intervention adherence in computerised interventions for mental health problems: a meta-analysis. Psychol Med. 2022;52:229\u0026ndash;40. https://doi.org/10.1017/S0033291721004621.\u003c/li\u003e\n \u003cli\u003eJohansson O, Michel T, Andersson G, Paxling B. Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study. Internet Interv. 2015;2:137\u0026ndash;42. https://doi.org/10.1016/j.invent.2015.02.006.\u003c/li\u003e\n \u003cli\u003eLawler K, Earley C, Timulak L, Enrique A, Richards D. Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study. JMIR Form Res. 2021;5:e26221. https://doi.org/10.2196/26221.\u003c/li\u003e\n \u003cli\u003eWan Mohd Yunus WMA, Matinolli H-M, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, et al. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res. 2022;24:e33337. https://doi.org/10.2196/33337.\u003c/li\u003e\n \u003cli\u003eBakanaitė R, Bakanienė I, Kanyeredzi A. Long-Term Effectiveness of Internet-Based Versus Traditional Cognitive Behavioral Therapy Across Psychiatric Disorders: A Systematic Review and Meta-Analysis. Telemed E-Health. 2025;31:1284\u0026ndash;96. https://doi.org/10.1177/15305627251358855.\u003c/li\u003e\n \u003cli\u003eHedman E, Lj\u0026oacute;tsson B, Kaldo V, Hesser H, El Alaoui S, Kraepelien M, et al. Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care. J Affect Disord. 2014;155:49\u0026ndash;58. https://doi.org/10.1016/j.jad.2013.10.023.\u003c/li\u003e\n \u003cli\u003eKambeitz-Ilankovic L, Rzayeva U, V\u0026ouml;lkel L, Wenzel J, Weiske J, Jessen F, et al. A systematic review of digital and face-to-face cognitive behavioral therapy for depression. Npj Digit Med. 2022;5:144. https://doi.org/10.1038/s41746-022-00677-8.\u003c/li\u003e\n \u003cli\u003eAlfonsson S, Olsson E, Linderman S, Winnerhed S, Hursti T. Is online treatment adherence affected by presentation and therapist support? A randomized controlled trial. Comput Hum Behav. 2016;60:550\u0026ndash;8. https://doi.org/10.1016/j.chb.2016.01.035.\u003c/li\u003e\n \u003cli\u003eBerger M. Envy and Generosity Between Co-Therapists. Group. 2002;26:107\u0026ndash;21.\u003c/li\u003e\n \u003cli\u003eHornova L. Dialogical Co‐therapy. Aust N Z J Fam Ther. 2021;41. https://doi.org/10.1002/anzf.1431.\u003c/li\u003e\n \u003cli\u003eHendrix CC, Fournier DG, Briggs K. Impact of Co-Therapy Teams on Client Outcomes and Therapist Training in Marriage and Family Therapy. Contemp Fam Ther. 2001;23:63\u0026ndash;82. https://doi.org/10.1023/A:1007824216363.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Successful qualitative research: a practical guide for beginners. Los Angeles: SAGE; 2013.\u003c/li\u003e\n \u003cli\u003eMalterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26:1753\u0026ndash;60. https://doi.org/10.1177/1049732315617444.\u003c/li\u003e\n \u003cli\u003eSvanborg P, Asberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994;89:21\u0026ndash;8. https://doi.org/10.1111/j.1600-0447.1994.tb01480.x.\u003c/li\u003e\n \u003cli\u003eSvanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). J Affect Disord. 2001;64:203\u0026ndash;16. https://doi.org/10.1016/s0165-0327(00)00242-1.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77\u0026ndash;101. https://doi.org/10.1191/1478088706qp063oa.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589\u0026ndash;97. https://doi.org/10.1080/2159676X.2019.1628806.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Thematic analysis: a practical guide. Los Angeles London New Delhi Singapore Washington DC Melbourne: SAGE; 2022.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Palliat Med. 2024;38:608\u0026ndash;16. https://doi.org/10.1177/02692163241234800.\u003c/li\u003e\n \u003cli\u003eCoates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. Health Soc Care Community. 2019;27:e389\u0026ndash;405. https://doi.org/10.1111/hsc.12740.\u003c/li\u003e\n \u003cli\u003eSingla DR, Lawson A, Kohrt BA, Jung JW, Meng Z, Ratjen C, et al. Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021;78:498\u0026ndash;509. https://doi.org/10.1001/jamapsychiatry.2020.4556.\u003c/li\u003e\n \u003cli\u003eSufredini F, Catling C, Zugai J, Chang S. The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review. J Affect Disord. 2022;319:119\u0026ndash;41. https://doi.org/10.1016/j.jad.2022.09.005.\u003c/li\u003e\n \u003cli\u003eAndersson G, K\u0026auml;ll A, Juhlin S, Wahlstr\u0026ouml;m C, de Fine Licht E, F\u0026auml;rdeman S, et al. Free choice of treatment content, support on demand and supervision in internet-delivered CBT for adults with depression: A randomized factorial design trial. Behav Res Ther. 2023;162:104265. https://doi.org/10.1016/j.brat.2023.104265.\u003c/li\u003e\n \u003cli\u003eKleiboer A, Donker T, Seekles W, van Straten A, Riper H, Cuijpers P. A randomized controlled trial on the role of support in Internet-based problem solving therapy for depression and anxiety. Behav Res Ther. 2015;72:63\u0026ndash;71. https://doi.org/10.1016/j.brat.2015.06.013.\u003c/li\u003e\n \u003cli\u003eBennett CB, Toevs EK, Angus A, Krawczak R, Trentacosta CJ, Jagadeesh D, et al. Meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome: A 10-year update. Clin Psychol Rev. 2025;121:102644. https://doi.org/10.1016/j.cpr.2025.102644.\u003c/li\u003e\n \u003cli\u003eVerhelst P, Sels L, Lemmens G, Verhofstadt L. The role of emotion regulation in perinatal depression and anxiety: a systematic review. BMC Psychol. 2024;12:529. https://doi.org/10.1186/s40359-024-02033-9.\u003c/li\u003e\n \u003cli\u003eAkbari M, Seydavi M, Hosseini ZS, Krafft J, Levin ME. Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis. J Context Behav Sci. 2022;24:65\u0026ndash;78. https://doi.org/10.1016/j.jcbs.2022.03.007.\u003c/li\u003e\n \u003cli\u003eKazma JM, van den Anker J, Allegaert K, Dallmann A, Ahmadzia HK. Anatomical and physiological alterations of pregnancy. J Pharmacokinet Pharmacodyn. 2020;47:271\u0026ndash;85. https://doi.org/10.1007/s10928-020-09677-1.\u003c/li\u003e\n \u003cli\u003eEkel\u0026ouml;f K, Tangen GA, Nystr\u0026ouml;m CD, L\u0026ouml;f M, Thomas K. Mental wellbeing during pregnancy and the transition to motherhood: an explorative study through the lens of healthcare professionals. BMC Pregnancy Childbirth. 2025;25:803. https://doi.org/10.1186/s12884-025-07894-5.\u003c/li\u003e\n \u003cli\u003eTak\u0026aacute;cs L, Zhang Z, Lee S, Putnam SP, Kaňkov\u0026aacute; \u0026Scaron;, Ullmann J, et al. Examining associations of temporal changes in maternal emotions and their biomarkers with the development of maternal-fetal bonding across pregnancy. Midwifery. 2025;149:104551. https://doi.org/10.1016/j.midw.2025.104551.\u003c/li\u003e\n \u003cli\u003evan Scheppingen MA, Denissen JJA, Chung JM, Tambs K, Bleidorn W. Self-esteem and relationship satisfaction during the transition to motherhood. J Pers Soc Psychol. 2018;114:973\u0026ndash;91. https://doi.org/10.5167/uzh-205994.\u003c/li\u003e\n \u003cli\u003eCuijpers P, Reijnders M, Huibers MJH. The Role of Common Factors in Psychotherapy Outcomes. Annu Rev Clin Psychol. 2019;15:207\u0026ndash;31. https://doi.org/10.1146/annurev-clinpsy-050718-095424.\u003c/li\u003e\n \u003cli\u003eHenriques G, Gralha M. The common core of psychotherapy: Bridging common factors with unification to frame the center of the field. J Psychother Integr. 2024;34:219\u0026ndash;45. https://doi.org/10.1037/int0000345.\u003c/li\u003e\n \u003cli\u003eBaier-Mosch F, Weiher GM, Kananian S. Determining what is common: A theoretical account of common factors in psychotherapy through the lens of self-determination theory. J Contemp Psychother Cut Edge Mod Dev Psychother. 2025. https://doi.org/10.1007/s10879-025-09664-y.\u003c/li\u003e\n \u003cli\u003eKaldo V, Ramner\u0026ouml; J, Jernel\u0026ouml;v S. Involving clients in treatment methods: A neglected interaction in the therapeutic relationship. J Consult Clin Psychol. 2015;83:1136\u0026ndash;41. https://doi.org/10.1037/ccp0000039.\u003c/li\u003e\n \u003cli\u003eBull E, Al-Janabi S, Gittins CB. Are women with traits of perfectionism more likely to develop perinatal depression? A systematic review and meta-analysis. J Affect Disord. 2022;296:67\u0026ndash;78. https://doi.org/10.1016/j.jad.2021.09.028.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antenatal depression, ICBT, Treatment, Pregnancy, Additional Support, Perinatal mental health, Reflexive thematic analysis, Blended treatment","lastPublishedDoi":"10.21203/rs.3.rs-9093942/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9093942/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Antenatal depression is common and often remains untreated. Few studies that have evaluated pregnancy-adapted internet-based cognitive behavioural therapy (ICBT). Although these studies indicate promising treatment effects, participants frequently report feelings of loneliness, being overwhelmed, and a desire for increased interaction. With the DANA-project, we attempt to address these needs by incorporating live support sessions to a pregnancy-adapted ICBT-treatment, providing increased support and contact with two clinicians. This study explores participants' experience of this treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted\u003cstrong\u003e \u003c/strong\u003ea qualitative study using semi-structured interviews with participants (n=20) who had received a 10-week guided ICBT for antenatal depression, complemented with live support sessions delivered by a midwife over video or telephone. The data were analysed using reflexive thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOne overarching theme was generated, named ‘\u003cem\u003eFeeling held over a distance – the interplay of Support and Obligation\u003c/em\u003e’, comprising three themes representing the participants’ experiences of the treatment. Participants described the treatment as supportive and validating, with many elements perceived as helpful, indicating that the key elements of the treatment were well received. Participants emphasized the value of the therapeutic relationship, the relevance of the content, and the emotional resonance of the treatment. At the same time, they experienced the program as demanding, reporting a high level of burden, both related to the illness itself, the treatment, and other life circumstances. A strong wish for personal tailoring was evident. The support sessions were valued, offering opportunities for individualised guidance and contributing to a deeper therapeutic relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in therapist-guided ICBT for antenatal depression with added live support sessions delivered by a counsellor, appreciated the treatment but reported substantial burdenthat may affect perceived feasibility. Personal tailoring of both structure and content was highly valued, and although this was described as present, participants expressed a desire for more. Feeling seen was repeatedly highlighted as a valued aspect of the intervention. These findings may informrefinement of perinatal digital interventions and guide future implementation efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eThe study was a sub-study in a prospectively registered randomized controlled trial conducted in Sweden, the DANA project. Trial registration: ClinicalTrials.gov, NCT05533138. Registered 9 September 2022.\u003c/p\u003e","manuscriptTitle":"Held over a distance: A qualitative study on patients’ experiences of Internet- based cognitive behaviour therapy (ICBT) for antenatal depression with added live support sessions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 16:17:10","doi":"10.21203/rs.3.rs-9093942/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-23T17:10:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T11:42:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T11:43:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T17:08:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-03-25T15:12:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a66e0c2-4f99-4674-860e-5c0977cfcb2e","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T16:17:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 16:17:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9093942","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9093942","identity":"rs-9093942","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}